Reflections on the occasion of the tenth anniversary of L’Initiative
When talking about L’Initiative, it is often said that it helps to better “articulate the multilateral and the bilateral”, but what exactly do we mean by these words? The tenth anniversary of L’Initiative is a great opportunity to reflect on its evolution and to collectively question the driving forces behind this famous dichotomy between the bilateral and the multilateral. We look back on these ten years with Stéphanie Tchiombiano.
A gradual increase in power
What strikes me first, when we look back on L’Initiative since its creation in November 2011, is obviously its gradual rise in power, both financially (with the gradual shift from 5% to 9% of the French contribution to the Global Fund) and operationally (with more than 10,000 days of expertise and around twenty new projects financed in 2020). But what strikes me even more, as a former coordinator, is the evolution of the team (and I can’t help but think of the small offices where L’Initiative took its first steps). Beyond the simple management of a technical assistance system, it seems to me that
what characterizes L’Initiative today is its ability to recruit diverse profiles, generate internal expertise and train new generations on international health issues . It creates, in a way, a “breeding ground” for the global health of tomorrow .
In ten years, L’Initiative has continued to cross borders
The Initiative could have been content to effectively mobilize experts to support access to and the effectiveness of Global Fund financing, but it went well beyond that, by participating in the structuring of this network of expertise and the training of consultants . It thus organized meetings between female and male experts, and stimulated the feminization of this network. The Initiative actively participated in the emergence of local expertise, for example by promoting the systematization of pairs of experts (bringing together a “local” expert and an “international” expert).
The Initiative could have been content to launch calls for projects on AIDS, tuberculosis and malaria, but it went much further. It gave an important place to research projects – and in this respect, it is well “ahead” of the Global Fund – while creating synergies between countries and between projects. Rather than systematically concentrating its funding on the most experienced project leaders, as the majority of donors do, the Initiative strengthened the capacities of certain project leaders that it considered less solid.
The Initiative could have been content to measure the effectiveness of its action, but it went well beyond that, by organizing cross-capitalization mechanisms between project leaders, by regularly disseminating its analyses during thematic conferences or by creating places and moments for collective reflection. I am thinking, for example, of the subjects of observatories of access to care or sexual and reproductive health.
Of course, there is still a long way to go, and these attempts have not always been fully successful, but this triple dynamic (stimulate, connect, support) is now deeply rooted at the heart of the system . We can criticize this development, consider that it is not in line with what was the “mantra” of L’Initiative when it was created (orientation on demand), but we can also be pleased with it. In fact, L’Initiative does much more than respond to a technical request. Today, it speaks out, it carries certain values, it ultimately makes political choices (in the noble sense of the term).
The Initiative is obviously a way of reintroducing the bilateral into the multilateral…
It is as if, by withholding part of its financial contribution to the Global Fund for the mechanism, France wanted to reaffirm its presence as a nation-state on the global health scene. The Initiative can be analyzed as a way for France to strengthen its influence at the multilateral level in different ways.
First, it strengthens the visibility of French involvement in the Global Fund. Each expert mission in the field is also an opportunity to recall the importance of French investment, on national stages, within the CCMs and with field actors.
The Initiative also focuses its efforts on priority countries for French ODA. It thus participates in a form of rebalancing of the strategic priorities of the Global Fund, by strengthening the capacities of French-speaking actors, by focusing attention on the “countries that matter” to France, even if they are not necessarily among the countries most affected by the three pandemics.
Then, the Initiative strengthens France’s position in the arenas of global health on the ground , mobilizing the positions and especially the regional global health advisors of the French embassies. It strengthens the latter’s capacities to create alliances, it gives them back a central place in local health negotiations, including when they have almost no (or no more) bilateral health funding. It can thus contribute, in a certain way, to strengthening bilateral relations between States.
Finally, L’Initiative carries certain messages from French diplomacy, for example when it asks each of the experts it sends to the field to follow a webinar on gender before leaving, or when it targets its calls for projects on strengthening health systems or on marginalized populations. These actions that it takes are a way of sending a signal to the international community, of carrying certain messages from France on the international scene and of declining them operationally . It is a question of bilateral in the multilateral..
…but it is also a way of reintroducing the multilateral into the bilateral
This analysis is less common, but we can also consider that the Initiative participates in what we could call a form of “multilateralization” of bilateral health aid.
Indeed, this system is a great tool for understanding the world and health issues for the French government. In direct contact with experts and realities on the ground, L’Initiative participates in the “feedback of information”. While it is obvious that it contributes in this way to the definition of French positions within the Global Fund, it is also a valuable source of information and inspiration for French public aid in the area of health , more generally and well beyond the Global Fund, including for France’s bilateral action.
Then, the Initiative creates a link between the French government and a large part of the French or French-speaking actors involved in global health, by financing their projects, mobilizing their expertise and creating bridges between them. It is an indirect opportunity for the French government to create, federate and retain a French-speaking network on global health issues, well beyond the multilateral issues of the Global Fund .
Last but not least, one of the particularities of L’Initiative, which makes it profoundly different from other technical assistance mechanisms or other funding windows, is the openness of its steering committee beyond public service actors. By choosing to include a representative of the French Red Cross, a representative of French research and two representatives of civil society, the steering committee itself gives L’Initiative a multilateral dimension. It is no longer just a mechanism piloted by the French government, but a multi-actor initiative, consistent with the principles of the Global Fund, which gives French action the richness and legitimacy of multilateral initiatives . It is multilateral in the bilateral.
These ten years of evolution of the Initiative are perfectly in line with the global reform of health aid, calling for the transition from a strictly “health” approach, centered on diseases, towards a more global, more “systemic” approach, embodied by the 2030 agenda, and involving all stakeholders.
The Initiative today embodies this renewal, going beyond the logic of cooperation in the “classical” sense of the term (from State to State), while remaining, as we have seen, and we must be well aware of this, an instrument of influence in the service of France.
