Source: https://www.hhrjournal.org/2013/10/funding-global-health/
Timestamp: 2019-04-25 22:41:56+00:00

Document:
Promising to provide financing as part of an intergovernmental call for commitment activates a rights-based approach. In education, for example, the right to education, identified in the Universal Declaration of Human Rights (UDHR), gained momentum when the Education Fund was created.3,4 The Education Fund finances primary school education in developing countries, and therefore provides concrete help to developing countries to realize the right to education for their citizens.5 For donor and recipient countries, the Education Fund embodies an actualization of their commitment to education as a right: the donors through their contributions and the recipients through their efforts to use the support to make education available.
Similarly, the FCGH will require rich and poor countries to collaborate on finding ways to meet their respective sovereign responsibilities to safeguard their citizens’ right to health. For rich countries, acknowledging a universal right to health may well include an obligation to assist countries who lack the resources to secure that right for their citizens on their own.6 Drawing from precedents in the environment, education, and global health sectors, an FCGH financing facility can encourage low-income country support. A financing facility can also provide a mechanism through which high-income countries may partially discharge the responsibilities that attach to their recognition of a universal right to health.
This essay aims to raise consciousness about the need for an FCGH financing facility. We also begin to envision what an FCGH financing facility should look like. The second section tracks the background of the financing facility phenomenon, the reasons it has emerged, the aspirations of the stakeholders who have fuelled it, and the pertinence of those aspirations to the framers of the FCGH. We show how three competing models for creating a financing facility currently coexist. In section three, we identify the essential elements that the creators of an FCGH facility will need to address, as gleaned from the precedents; namely multi-stakeholder participation, technical expertise, resource mobilization, and resource allocation. Section four provides a preliminary sketch of the preferred approach for an FCGH financing facility.
The emergence of global financing facilities began with the GEF’s creation in 1994, springing from an ongoing quest by donors, recipients, and other stakeholders to find the optimal way to deliver financial assistance to those actors most likely to use it to address the identified global problem or need. A preliminary statement about the meaning of optimal in this context is appropriate here.
When parties agree to address a global need together, several layers of decision making are at play. At a fundamental level, the parties identify the substantive objectives of their collective international commitment, for example: universal primary school education by 2015, HIV/AIDS eradication, or reduction of greenhouse gas emission levels to 1990 levels. This is a first order decision. International agreement on the desirability of attaining these objectives sparks the next level of decision making—the specific actions and activities that must be carried out in order to attain the agreed objectives. The decision to provide developing countries funding to undertake those actions or activities may then follow. This third level of decision making is the focus of this article. At this level, those creating the financing facility aim to identify the collective financing model that maximizes the likelihood that the facility’s funds will reach the beneficiaries most likely to use them for activities and actions that the facility’s contributors decide are necessary to achieve their collective goals.
The precedents offer three competing models. This article does not purport to state which of these models is preferred on an empirical basis. The research needed to support such a claim has not been done. Instead, this article shows, from a theoretical perspective, which approaches minimize agency costs and maximize accountability and participation. These attributes provide no guarantee that funding provided by a facility that has these attributes will be effective. However, these attributes are generally associated with improving the likelihood that funding will reach its intended targets, that both the target beneficiaries and the approved action or activity will have credibility, and that there will be buy-in from those whom funding is intended to assist.7 In other words, having these attributes is associated with being an optimal financing facility.
The threshold question that sovereign creators of any new global financing facility must address is the question whether and why they need a new facility. After all, there are legacy institutions – the World Bank (Bank), the UN, and WHO, set up to address development and health needs. Aren’t these, then, the institutions that sovereigns should turn to when a development and/or health need arises?8 In truth, however, the emergence of the financing facility norm that began with the GEF reflects a loss of confidence in the capacity of those institutions to address the need in question.
In the Traditional Trust Fund model, contributors agree on broad objectives for the fund but surrender control to the entity serving as trustee (typically a legacy institution) to select what projects get funded and to administer the fund in accordance with its standard operating policies.13 Although this model has fallen into disfavor as being too legacy institution-centric, it is still in use. The Avian Flu and Swine Flu Facilities, created in 2006 and 2009, respectively, use this model.14 The Health Results Innovation Trust Fund, created in 2007, is also based on this model.15 All three of these funds are relatively narrow in scale and time bound, key factors influencing the choice of the Traditional Trust Fund model. Avian and Swine Flu have been seen as immediate but addressable and relatively short-term problems (in contrast, for example, to HIV/AIDS). As its name implies, the Avian Flu Facility aims to minimize the risk of avian influenza (and other zoonoses) and of a possible human pandemic influenza in developing countries that lack adequate domestic resources and capacity to combat the disease.16 Similarly, the Swine Flu Facility aims to help control the spread of swine flu, A/H1N1.17 The Health Results Innovation Fund, meantime, pilots results-based financing schemes for health services that reduce infant mortality and improve maternal health. It was not created to be an indefinite life support. The World Bank, as trustee of these funds, makes all key decisions in their day to day implementation.
Under the Quasi-Entity Fund model pioneered by the GEF, the fund’s creators set the new facility up as a trust fund with the World Bank named as trustee. They do not, however, give the World Bank full power over the fund. Instead, the creators control the allocation of the fund’s resources themselves. They reduce the trustee role to rudimentary financial management. The GEF’s creators pushed for a model different from the Traditional Trust Fund because they deemed the agency costs of putting the World Bank in control of the fund too high. At that time, the Bank had a dismal record on environmental protection and the GEF’s creators were concerned that the Bank, if left in control, would use the fund’s resources to further the Bank’s lending agenda at their agenda’s expense.18 At the same time, the GEF’s creators wanted to avail themselves of the Bank’s financial management experience.
Following the GEF’s creation, the popularity of the Quasi-Entity Fund model exploded and fast became the norm rather than the exception for setting up a collective financing mechanism to achieve development goals.22 No subsequent fund replicated the GEF exactly, but the same basic components of the Quasi-Entity Fund structure and the same driving forces behind their creation apply to subsequent funds. The structure always involves: one or more governing bodies comprised wholly or primarily of contributors that meet periodically during the year to make funding decisions, a dedicated secretariat to manage the fund day-to-day, and World Bank-provided financial management services.
In practice, the Quasi-Entity Fund model fails to achieve the goal of doing things differently from the legacy institutions. The model has limitations that stymie its potential to reduce agency costs and that generate accountability concerns.29 The Quasi-Entity Fund’s limited ability to reduce agency costs arises from the fact that the structure does not provide for independent legal status. This means that a Quasi-Entity Fund has no capacity to enter into contracts on its own behalf. For example, a Quasi-Entity Fund cannot hire staff for the fund secretariat. This lack of legal capacity means that instead of a Quasi-Entity Fund’s secretariat being employees of the fund, they end up being World Bank employees. This is because the World Bank, as trustee of the fund, is the only entity with formal legal capacity to act on the fund’s behalf.30 Although these funds are set up as Quasi-Entity Funds precisely because their creators want to do things differently than the Bank, from the time they are hired, their secretariat staff are placed in the impossible position of having to serve two masters with conflicting agendas.
Having rejected the Traditional Trust Fund model and the World Bank policies and procedures that automatically apply under that model, the creators of a Quasi-Entity Fund must enact an alternative accountability framework. Such accountability gaps have actual and potential negative outcomes. These include failure in the oversight of the funds’ resources resulting from misaligned responsibilities among the fund’s organs, liability and reputational risk for donors and the World Bank, and the application of ad hoc rather than optimal fiduciary practices.37 The accountability gaps in the Quasi-Entity Fund model are curable once acknowledged and addressed. Accountability may be achieved by specifying what other policies and procedures apply and by creating checks and balances to ensure they are implemented. It is the unacknowledged lacuna that gives rise to an accountability deficit. The agency costs that arise from the Quasi-Entity Fund model’s lack of independent legal capacity, however, are an intractable deficit.
The key drawbacks of the New Legal Entity model are the enormous commitment and costs involved in setting up an entirely new legal entity, complete with fund-specific policies, procedures, and processes. The administrative costs are also formidable. The creators of a new initiative invariably start out by declaring that the new initiative will be a lean, mean financing machine, an implicit rebuke to the legacy institutions, which are perceived as bloated bureaucracies. That goal translates initially into a skeletal secretariat staff, charged with the perfunctory tasks of serving as the repository of new proposals, convening meetings, handling logistics, and serving as the key purveyor of information about the initiative to the outside world. But quickly, the secretariat expands and frequently adds to its functions the preparation of technical papers and other substantive and qualitative responsibilities that require a substantial staff. Both the Global Fund and GAVI Alliance have followed this trajectory. The danger here is that the secretariat becomes one more bloated bureaucracy.
Taking stock of the precedent models, it is clear that none of the existing models are optimal. The Quasi-Entity Fund jumpstarted the move away from the fusion involved in the Traditional Trust Fund. It sowed the seeds for the New Legal Entity model. Its intractable agency costs, however, make it a disfavored model. The New Legal Entity model offers advantages, but the proliferation of autonomous institutions, each with institution-specific policies, procedures, and processes gives cause for concern on many levels—coordination, duplication, and high administrative costs among them. For these reasons, the creators of an FCGH financing facility should aim for a new approach that both staunches proliferation and incorporates best practices from the precedent entities. What we need is an umbrella framework that allows different global health initiatives to retain their respective identities and fill their particular niches, but provides for a single set of policies, procedures, processes, and standards to apply across the spectrum. Before considering how the formal contours of such an umbrella framework might work, it is worth examining the essential elements it would have to incorporate.
The precedents indicate that several elements are key to the credibility and staying power of any financing initiative. These elements include (i) multi-stakeholder input, (ii) access to cutting edge expertise, (iii) the capacity to mobilize resources from a variety of sources and mechanisms; and (iv) qualifying conditions on which the facility’s resources will be allocated.
The legacy institutions have been faulted for affording inadequate voice to developing countries, nongovernmental organizations, and civil society.46 Their exclusively governmental nature also inhibits the scope of their interaction with foundations and the for-profit private sector. The GEF made strides in multi-stakeholder decision making, giving non-donor countries a say in the allocation of the fund’s resources.47 It also gives nongovernmental organizations observer status at meetings of its governing bodies But the health sector has taken more radical steps towards multi-stakeholder participation.
The Global Fund represents a novel approach to multi-stakeholder participatory governance.48 Its governing bodies reflect two key goals of its proponents: the capacity to function at the country level, informed by local needs and practices; and the capacity to incorporate the for-profit (especially pharmaceutical corporations) and not-for-profit (especially nonprofit organizations involved in health care delivery in developing countries) arms of the private sector.
The fund tackles potential concerns about participants’ accountability by pursuing detailed procedures for selecting board and CCM participants from large pools of eligible organizations.58 For example, its system for rotating NGO representatives allows for a continual monitoring of NGO representatives’ bona fides. These procedures, therefore, provide reassurance that representatives who participate are accountable entities at their selection and throughout their participation.
The technical advisory body is a core component of any new initiative’s governance structure because it is the initiative’s avenue to up-to-the minute scientific and technical research on which funding decisions will be based. The precedents provide insight into the kind of criteria that creators of a new initiative must set to ensure the ongoing quality of this advisory body. They also illustrate the kind of processes required to ensure that this body’s input feeds into funding decisions. The GEF introduced the idea of having a scientific and technical advisory panel (STAP) as part of an initiative’s governance structure. The global health initiatives have advanced the design of such a body to a fine art.
GAVI Alliance has a heavy representation of technical experts on its board and also relies heavily on an Independent Review Committee composed of an interdisciplinary team of independent experts identified and nominated by board members.72 This process was recently queried by an external review of GAVI Alliance’s Independent Committees which suggested that an open and competitive appointment of members would provide greater assurance and transparency of independence.73 Nonetheless, the Global Fund and GAVI Alliance offer highly evolved processes for securing technical and scientific input to inform their decision making. Other initiatives, such as the Green Climate Fund, which has yet to assemble its expert body, are likely to follow suit.
The AMC was launched by a group of government donors and the Gates Foundation in 2007 to provide vaccine manufacturers an incentive to develop and produce affordable vaccines tailored to the needs of developing countries.80 It began with a pilot scheme to create a market for vaccines against pneumococcal disease which went into effect on June 12, 2009.81 The AMC effectively guarantees vaccine manufacturers a pre-agreed price for target vaccines.82 Notably, the AMC’s operations involve the active engagement of several of the legacy institutions, including the World Bank, WHO, and UNICEF. Under the AMC’s framework arrangements, the Word Bank holds donor contributions to the AMC on trust, pending their disbursement to GAVI Alliance for vaccine purchases. WHO pre-qualifies vaccines as an initial step in their being deemed eligible for AMC funding, and UNICEF handles the procurement of eligible vaccines.83 However, the AMC’s principal governing body, which is dominated by unaffiliated technical experts, drives funding decisions.
Grants are the sole form of support the Education Fund provides and, also, the primary form of support the GEF has provided (though its charter provides for it to provide support in other forms). The Green Climate Fund’s charter, however, authorizes the fund to use a range of financing and co-financing instruments which allows for maximum flexibility as it forms its allocation strategies.
As the precedents show, the international community has changed how it mobilizes, disburses, and administers finance intended to help low-income countries address global problems. A new generation of global financing arrangements has emerged with a preference for creating new autonomous entities. The question arises, however, whether the world; donor and recipient nations; and other stakeholders, are optimally served by this host of new, autonomous legal entities designed to address a range of global needs. We suggest that the answer to this question is no. The precedent financing initiatives set in motion a vital process of change. That process began with the GEF’s introduction of the Quasi-Entity Fund, progressed to the Global Fund’s bold step in setting up a national legal entity under Swiss law, and culminated with the Green Climate Fund’s creation as an independent entity in both national and international law. But the time has come for the process to mature to enable all interested parties to reap the benefits of the changed norm while staunching needless proliferation.
So what might be an alternative to proliferation? The pre-1990s alternative was to have one model, the Traditional Trust Fund,which piggy-backed on the administrative and operational policies of the legacy institution serving as trustee while ceding all control of the initiative to the trustee. By voting with their feet, the creators of the post-1990 initiatives frequently reject that model as inadequate to meet today’s needs. We want more of a multi-stakeholder approach and greater flexibility than the legacy institutions allow. What’s been lost in moving away from that unitary model, however, is the ability of a new initiative to incorporate and rely on policies, procedures, and operational practices that reflect years of institutional history and work quite well.
These policies, procedures and operational practices include, for example, operational policies covering both fiduciary and social safeguards. In the area of fiduciary safeguards, for example, they cover procurement policies; practices for assessing potential recipients’ financial management capacity; and financial reporting standards. In the area of social safeguards, they address such matters as minimum environmental standards and the treatment of indigenous groups. The unitary model also has well defined administrative policies, such as human resources policies to govern the terms and conditions of employment governing a secretariat staff.
What we need, therefore, to replace the unitary model, is an umbrella framework that does not subjugate a new initiative to a legacy institution, but offers a template of policies, procedures, processes and standards. Different financing initiatives set up in accordance with the framework could retain their respective identities and fill their particular niches without reinventing standard processes and while still availing of best practices. One can visualize the umbrella framework operating like a food court in a mall: a cluster of distinct initiatives with distinct agendas and funding sources, but all availing of choice of template forms for their governance structure and standard operating procedures provided for under the framework. As done by the Global Fund and Green Climate Fund, initiatives created within the framework could draw upon the financial management services of the World Bank, again, avoiding the need to reinvent boiler plate financial management services.
The templates available under the umbrella framework could be devised using a mix and match approach that borrows liberally from different aspects of precedent initiatives that reflect best practices. For example, in the area of multi-stakeholder input, the uniform framework could include a template that sets standards for assessing and monitoring representatives based upon vetting processes devised by the Global Fund. The precedents show this kind of cherry picking of policies and practices can be done at an initiative level. The AMC, for example, has a multi-stakeholder governing body like the Global Fund. It also avails of the basic financial management practices of the World Bank, the procurement policies of either the Bank or UN, and the technical know-how of WHO. At the same time, the AMC’s use of these pre-existing practices is supplemented by additional specialized vetting committees, customized by the AMC, to conduct AMC-specific, specialized reviews. The fluidity of this kind of approach enables a new initiative to incorporate best practices based on the lessons of experience.
Though the precedents at an initiative by initiative level have laid the groundwork for an umbrella framework approach, the formal embrace of such an approach by the international development community and international legal order has not yet occurred. So how should the supporters of an FCGH financing facility proceed in the meantime? They could, of course, create a new autonomous FCGH financing entity that would operate alongside the Global Fund, GAVI Alliance, and other smaller global health initiatives that currently exist. This would follow the approach taken by the Green Climate Fund’s creators. The Green Climate Fund’s charter establishes a wholly new institution and provides for it to devise a host of new policies and procedures. This charge presents significant potential for reinventing the wheel at great cost. It therefore seems an ill-advised course for the supporters of a FCGH facility to follow.
Alternatively, the supporters of an FCGH facility could expand the size of the Global Fund and the mandate of its governing bodies to become the FCGH Fund. The difficulty here might be that the Fund’s singular focus on HIV/AIDS, malaria, and tuberculosis and its public persona as a fund dedicated to those diseases may make it an inadequate anchor for a facility that is much broader in scope.
A third alternative would be to pioneer the umbrella framework approach described above, as an umbrella framework for global health financing. Under this approach, the different global health financing initiatives would retain their respective identities and fill their particular niches. The framework, however, would provide ready templates for new initiatives created to fill the gaps. The precedent initiatives form a robust base from which to build the template governance structures and administrative and operational policies for such a framework. Moreover, the precedents have forced the legacy institutions to open up to the possibility of change. Key stakeholders, including representatives of the Global Fund, GAVI Alliance, WHO, the World Bank, along with donors, would have to agree on how to divide responsibility for devising and maintaining the framework.
Ideally, this framework approach would allow for an FCGH financing facility that reflects the optimal degree of fusion and autonomy without adding further to institutional proliferation. The goal would be to achieve an integrated approach that (i) makes use of the legacy institutions’ services in those areas where they have a comparative advantage, and (ii) draws upon the considerable investment that has already been made by a range of new and old institutions to devise standard operating procedures.
The FCGH is a bold and innovative move in global health. It could also pioneer a bold and innovative move in international financing for development.
Sincere thanks to Erica Dressler and Temple Law Librarian Noa Kaumeheiwa for excellent research assistance.
Anna Triponel, L.L.M., is the former Governance Officer of the Global Partnership for Education housed at the World Bank in Washington, DC.
Please address correspondence to Sophie Smyth, Beasley School of Law, Temple University, Philadelphia, Pennsylvania 19122, USA.
1. UN Framework Convention on Climate Change (UNFCCC) (1992), Art. 11. Available at http://unfccc.int/essential_background/convention/background/items/1377.php.
3. Universal Declaration of Human Rights (UDHR), G.A. Res. 217A (III) (1948). Available at http://www.un.org/en/documents/udhr/index.shtml.
4. The fund was created by some of the countries who founded Education for All (EFA);World Bank, “The global partnership for education and the World Bank.” Available at http://go.worldbank.org/8EZE2MXEZ0.
5. Global Partnership for Education, Financing education: Background and origins (2013). Available at http://www.globalpartnership.org/our-work/financing-education/.
6. A. Sen, Development as freedom (New York: Alfred A. Knopf, 1995).
7. D. G. Hawkins, D. A. Lake, D. L. Nielson, and M. J. Tierney, “Delegation under anarchy: States, international organizations, and principal-agent theory,” in D. G. Hawkins, D. A. Lake, D. L. Nielson, and M. J. Tierney (eds.), Delegation and agency in international organizations (Cambridge, UK: Cambridge University Press, 2006); R. W. Grant and R. O. Keohane, “Accountability and abuses of power in world politics,” American Political Science Review 99/1 (2005), p. 29; S. Smyth, “A practical guide to creating a collective financing effort to save the world: The global environment facility experience,” Georgetown International Environmental Law Review 22/1 (2009), pp. 29-97; S. Smyth, “NGOs and legitimacy in international development,” University of Kansas Law Review 61 (2013), pp. 377-439.
8. S. Smyth, “Collective action for development finance,” University of Pennsylvania Journal of International Law 32/4 (2011), pp. 961-1055. Available at http://www.globalpartnership.org/our-work/financing-education.
9. Smyth (2011, see note 8).
11. See Ibid; Hawkins et al. (see note 7), p. 9; M. Ivanova, “Institutional design and UNEP reform: Historical insights on form, function and financing,” International Affairs 88/3 (2012), p. 565; R. W. Grant and R. O. Keohane (see note 7), p. 29.
12. Smyth (2011, see note 8).
13. Smyth (2011, see note 8), p. 968.
14. Avian and Human Influenza Facility, AHI Facility document (2007), p. 3. Available at http://siteresources.worldbank.org/INTTOPAVIFLU/Resources/AHI.Facility.Rocio.May07.pdf; Wall Street Journal, World Bank approves $500M fast-track facility for swine flu (2009). Available at http://online.wsj.com/article/BT-CO-20090602-714268.html.
15. The World Bank, The World Bank and Results-Based Financing for Health. Available at http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/Partnerships/436970-1281725189197/RBFforHealthOverview.pdf.
16. AHI Facility document (see note 14).
18. Smyth (2011, see note 8), p. 992.
19. Global Environment Facility, Instrument for the establishment of the restructured Global Environment Facility (Washington, D.C.: GEF, 2011), pp. 15-19. Available at http://www.thegef.org/gef/instrument.
20. For small proposals, the Council may delegate this power to the Secretariat. GEF Council Document, Small Grants Programme: Execution arrangements and upgrading policy for GEF-5 (GEF/C.36/4; 2009). Available at http://www.thegef.org/gef/sites/thegef.org/files/documents/C.36.4%20Small%20Grants%20ProgrammeFINAL.pdf.
21. Smyth (2009, see note 7).
22. Smyth (2011, see note 8).
23. Ibid. United Nations Educational, Scientific and Cultural Organization (UNESCO), EFA global monitoring report 2010: Reaching the marginalized (Paris: UNESCO, 2010), p. 432. Available at http://www.unesco.org/new/fileadmin/MULTIMEDIA/HQ/ED/GMR/pdf/gmr2010/gmr2010-annex-05-aid.pdf.
24. Smyth and Triponel, “Education as a lynchpin of development: Legal and policy considerations in the formation of the education for all—Fast Track Initiative Catalytic Trust Fund,” Sustainable Development, Law, and Policy 6 (2005) pp. 8-10.
27. Education For All Fast-Track Initiative, Framework (2004), p. 7. Available at http://www.educationfasttrack.org/media/library/FrameworkNOV04.pdf.
28. Smyth and Triponel (2005, see note 24), p.; S. Smyth, “Agency and accountability in multilateral development finance: An agenda for change,” The Law and Development Review 4/1 (2011a), pp. 65-140.
30. S. Smyth, “Can business learn to love the environment? The case for a U.S. corporate carbon fund,” Rutgers Law Review 58/2 (2006), pp. 451-510.
31. Smyth (2011, see note 8), pp. 1015-1019.
32. Education for All – Fast Track Initiative, FTI Reforms: Reinvigorating the Partnership, Strengthening support for EFA Results. Available at http://www.globalpartnership.org/media/library/Secure/Board_Documents_May-2010/Final_FTI_Reform_final.pdf.
34. Smyth 2011a, see note 28) pp. 105-111.
35. Smyth (2011a, see note 28), p. 109. Accountability, as defined in the seminal work by R. W. Grant and R. O. Keohane, “Accountability and abuses of power in world politics,” pp. 29-43 pp. 29-43 (see note 7).
37. Smyth (2011a, see note 28), pp. 117-118.
38. Smyth (2013, see note 7) pp. 410-411.
39. Global Fund, By-Laws (amended November 21, 2011), p. 1. Available at http://www.theglobalfund.org/en/about/structures/board.
40. Ibid., Art. 7, pp. 2-3.
41. GAVI Alliance, “What we do (2013).” Available at http://www.gavialliance.org/about/mission/what/.
42. GAVI Alliance, Board composition. (2013). Available at http://www.gavialliance.org/about/governance/gavi-board/composition/.
43. Green Climate Fund, Governing Instrument for the Green Climate Fund, UNFCCC Doc. No. FCCC/CP/2011/9/Add.1 (2011), pp. 2, 9. Available at http://gcfund.net/fileadmin/00_customer/documents/pdf/GCF-governing_instrument-120521-block-LY.pdf.
44. Ibid., p. 3 (Section II,B,7).
45. C. F. Amerasinghe, Principles of the institutional law of international organizations, Second Edition (New York: Cambridge University Press, 2005), pp. 92-100; Smyth (2011a, see note 28), pp. 122-124.
46. R. B. Zoellick, “The end of the Third World? Modernizing multilateralism for a multipolar world,” Law and Business Review of the Americas 16/3 (2010), pp. 371-384.
47. Global Environment Facility (2011, see note 19), pp. 15-19.
48. Smyth (2013, see note 7) pp. 398-99; A. Triponel, “Global Fund to fight AIDS, tuberculosis and malaria: A new legal and conceptual framework for providing international development aid,” North Carolina Journal of International Law and Commercial Regulation 35 (2010), pp. 173-232.
49. Global Fund, By-Laws (2011, see note 39), p. 6, Art. 7.4.
50. Definition of the Term Civil Society, 8th Policy and Strategy Committee Meeting, Geneva, September 19-21, 2007, GF/PSC8/07 (2007).
51. Global Fund, By-Laws (2011, see note 39), Global Fund, “Board, Art. 7. Ibid.
52. Global Fund, Guidelines and requirements: CCM guidelines and guidance notes (2013). Available at http://www.theglobalfund.org/en/ccm/guidelines/.
53. Global Fund, Framework document (Geneva: The Global Fund, 2012), pp. 94-95. Available at http://www.theglobalfund.org/documents/core/framework/Core_GlobalFund_Framework_en/.
54. D. Brakman Reiser and C. R. Kelly, “Linking NGO accountability and the legitimacy of global governance,” Brooklyn Journal of International Law 36 (2011), pp. 1011-1073.
55. Global Fund, Global Fund Governance Handbook Section 7: Board Constituencies. Available at http://www.theglobalfund.org/en/library/documents/.
56. Global Fund (2011, see note 39), Art.7.1; Global Fund, Operating Procedures of the Board and Committees (amended November 21, 2011), Annex 1 at p. 53. Available at http://www.theglobalfund.org/en/library/documents.
57. Global Fund, “Guidelines and requirements: CCM guidelines and guidance notes.” Available at http://www.theglobalfund.org/en/ccm/guidelines.
58. For an indication of the kinds of concerns that arise, see K. Anderson and D. Reiff, “Global civil society: A skeptical view,” in H. Anheir, M. Glasisus, and M. Caldor (eds.), Concepts of global civil society (London: Sage, 2004), pp. 26-39.
59. Global Partnership for Education, “Catalytic Fund.” Available at www.educationfasttrack.org/financing/catalytic-fund.
60. GAVI Alliance, “Industrial country pharmaceutical.” Available at http://www.gavialliance.org/about/partners/industrialised-country-vaccine-industry.
61. GAVI Alliance Statutes (2008), Art. 13. Available at http://www.gavialliance.org/resources/GAVI_Alliance_Statutes.pdf. See GAVI Alliance By-Laws (revised 2010), Art. 3. Available at http://www.gavialliance.org/resources/GAVI_Alliance_By_laws.pdf.
62. GAVI Alliance Statutes (2008), Art. 9. Available at http://www.gavialliance.org/resources/GAVI_Alliance_Statutes.pdf; GAVI Alliance, “Board members.” Available at http://www.gavialliance.org/about/governance/boards/members/index.php.
63. GAVI Alliance, Inter-agency coordination committee (ICC). Available at http://www.gavialliance.org/glossary/f-j/; GAVI Alliance, Handbook at 17, available at http://www.gavialliance.org/resources/Handbook_in_English.pdf.
65. J. Putzel, “The global fight against AIDS: How adequate are the National Commissions?” Journal of International Development 16/8 (2004), pp. 1129-1140; Organization for Economic Cooperation and Development, Do no harm: International support for statebuilding (Paris: OECD, 2010), pp. 9-27.
66. Global Environment Facility, The GEF and civil society organizations, a strategic partnership (May 2010) p. 5. Available at http://www.thegef.org/gef/sites/thegef.org/files/publication/GEF_CSO_partnership-CRA.pdf; Green Climate Fund, Governing Instrument (2011, see note 43).
67. Smyth (2013, see note 7) pp. 432-439.
68. Global Fund, Technical review panel (2013). Available at http://www.theglobalfund.org/en/trp/.
72. GAVI Alliance By-Laws (2010, see note 62, Art. 5.1).
73. GAVI Alliance, Review of Independent Review Committees. Available at http://www.gavialliance.org/results/evaluations/irc-review.
74. The Global Fund has had three replenishments – in 2005, 2007 and 2010.Global Fund, Replenishment mechanism (2013). Available at http://www.theglobalfund.org/en/donors/replenishment/. GAVI held its first formal replenishment pledging process in 2010. GAVI Alliance, Call for action and resources (October 2010). Available at http://www.gavialliance.org/funding/how-gavi-is-funded/resource-mobilisation-process/call-for-action-and-resources-october-2010/.
75. PRODUCT (Red) and the Global Fund, Available at http://www.theglobalfund.org/en/donors/private/red/; Innovative Financing Debt2Health_ Factsheet, Available at www.theglobalfund.org/documents/innovative_financing/InnovativeFinancing_Debt2Health_Factsheet_en.
76. GAVI Campaign, see note 75.
77. GAVI Alliance, Institutional timeline. Available at http://www.gavialliance.org/about/mission/origins/. IFFIm, “Overview.” Available at http://www.iffim.org/about/overview.
78. IFFIm, “Overview” (see note 77).
79. GAVI Alliance, Innovative finance (2013). Available at http://www.gavialliance.org/funding/how-gavi-is-funded/innovative-finance.
80. Department of Treasury, “Launch of the AMC Initiative” (June 12, 2009). Available at http://www.dt.tesoro.it/en/eventi/dettaglio.html?resourceType=/modules/eventi/elem_0110.html.
81. GAVI Alliance, AMC annual report 2009-2010 – background (Geneva: GAVI Alliance, 2010). Available at http://www.gavialliance.org/library/gavi-documents/amc/.
82. GAVI Alliance (2010, see note 106), p. 10.
83. GAVI Alliance, AMC annual report 2009-2010 – The AMC process: An overview (2010), p. 10. Available at http://www.gavialliance.org/library/gavi-documents/amc/.
84. Global Fund, Guidelines for proposals round seven 35 (2007). Available at ado.3cdn.net/cOff9fcc.72e189d85b_u3m6b93oe.pdf.
85. GAVI Alliance, “Types of support.” Available at http://www.gavialliance.org/support/what/index.php.
86. GAVI Handbook, p. 58. Available at http://www.gavialliance.org/resources/Handbook_in_English.pdf.
88. Global Fund, Partnership Strategy, Core_Partnership_Strategy-en.pdf. Available at http://www.theglobalfund.org/en/about/partnership.
89. GAVI Handbook, p. 11. Available at http://www.gavialliance.org/resources/Handbook_in_English.pdf.
90. Paris Declaration on Aid Effectiveness (2005). Available at http://www.oecd.org/dac/effectiveness/34428351.pdf.

References: Art. 11
 Art. 7
 Art. 7
 Art. 7
 Art.7
 Art. 13
 Art. 3
 Art. 9
 Art. 5