As its Board meets this month in Accra, Ghana, for its 25th meeting, the Global Fund to fight AIDS, Tuberculosis, and Malaria finds itself at a crossroads. Major reforms are needed to ensure its survival. The final report of a High-Level Independent Review Panel, which was tasked to examine the Global Fund's operations in light of allegations of fraud, made six recommendations. The Global Fund, it argued, must transition from an emergency to a sustainable response; develop new risk-management approaches; strengthen internal governance; institute a new grant-approval process; strengthen decision making by middle management; and "get serious about results". As the panel aptly noted, the Global Fund must "change or wither". The Global Fund Board has put in place an action plan that responds to these recommendations.
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