L’Initiative: 10 Years Fighting Pandemics

In 2021, L’Initiative celebrated its 10 years of existence. What is your takeaway after a decade of fighting pandemics?

Since it was created in 2011, L’Initiative has undergone remarkable operational, financial, and human growth. Its figures are impressive: Over 600 expertise missions have been deployed and over 150 projects funded. But beyond these results, L’Initiative’s ability to complement the Global Fund’s action should be commended: It has helped strengthen the coherence of France’s investments in global health.

L’Initiative’s projects with a catalytic dimension — mostly those concerning vulnerable populations — enable actions targeting key populations. These projects are vital to the fight against pandemics and require specific skills and procedures, which prove more difficult to deploy in the context of a Global Fund grant.

We receive feedback concerning L’Initiative’s efficiency through our diplomatic network — especially from our regional global health advisors — but also through our partners for whom L’Initiative plays an essential role in the 40 countries where it operates. France makes it a point to pass on the L’Initiative experts’ field knowledge, assessments, and analyses. Indeed, these provide valuable clarification for the Global Fund board, be it in the fight against tuberculosis (TB), the strengthening of health systems, or other cross-cutting themes (e.g., the right to sexual and reproductive health, gender equality, and inclusion of key populations in the Global Fund’s governance bodies).

Faced with the Covid-19 crisis, L’Initiative was able to step up its support rapidly: 41.7 million euros were invested in 2020, including 9.5 million euros for technical assistance. In 2021, 29 technical assistance missions made it possible to mobilize 500 million euros in grants from the Global Fund dedicated to the Covid-19 response.

Beyond figures, L’Initiative has succeeded in creating a rich ecosystem of stakeholders from the French-speaking world (e.g., experts, researchers, and community health workers), who work together for global health.

In 10 years, L’Initiative has made it possible to deploy over 600 expertise missions and finance 150 projects.

What are L’Initiative’s greatest assets?

Unquestionably, L’Initiative’s added value lies in its fine knowledge of the field, key populations, and those who empower these latter the most: Community workers, who are vital partners in the fight against pandemics. By supporting these stakeholders, L’Initiative helps them better structure their actions. This collaboration also helps measure the actual impact of the Global Fund’s grants, to which France contributes massively. For example, we can mention our project in the Mekong Basin, in Cambodia, to fight malaria among forest populations: Last year, only 29 cases were reported, and no deaths! L’Initiative is full of such projects aimed at key populations needing to be reached “to the last mile.”

L’Initiative also ensures that the supported projects are sustainable and help countries take ownership. Another example: In February 2019, France launched the Presidential Initiative for Health in Africa (IPSA in French) to help Burundi, Burkina Faso, Mali, Niger, the Central African Republic, and more recently, the Democratic Republic of the Congo in implementing Global Fund grants so they can accelerate their pandemic response. The objective is to link the fight against pandemics to the strengthening of health systems. Working alongside national authorities and with health ministries, in particular, high-level technical experts provide tailored assistance to governments in the programming and decentralized implementation of Global Fund grants.

What do you think are the challenges of the coming decade?

Efforts to eliminate HIV/AIDS, TB, and malaria should, of course, be sustained. We can still improve the efficiency and impact of Global Fund grants. L’Initiative can continue to provide complementary support by keeping up the deployment of on-site experts throughout countries and at the side of government officials. Countries will then assume ownership better in the fight against the three diseases and the strengthening of their health systems. That’s because one of the biggest challenges in the next decade will be reinforcing the various pillars supporting health systems, including community networks. The major concerns are the hiring of healthcare personnel, which we know are greatly lacking in many countries; the strengthening of laboratory networks; and, more broadly, the mobilizing of domestic resources. These are areas in which L’Initiative remains available to assist countries in fighting the three pandemics, prepare for future crises, and achieve universal healthcare coverage.

Interview conducted in May 2022