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The AIDS Pandemic pp 149–169Cite as

Enhancing Program Delivery

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Abstract

As the AIDS pandemic escalated, it was essential that the global community had a leader to coordinate and direct its response, and the Global Programme on AIDS (GPA) was pivotal in this role. As its new Director, Michael Merson made essential organizational changes within GPA to improve the Program’s performance and increase donor confidence in GPA’s leadership. This chapter describes how GPA strengthened the global response by: containing the global spread of HIV; reviewing and enhancing the performance of national programs; addressing human rights; and improving coordination. We detail how Merson navigated the internal politics of the World Health Organization (WHO), as he undertook to shift more responsibility from GPA in WHO headquarters to the WHO regional offices. This chapter also covers GPA’s efforts to continue a close partnership with non-governmental organizations and advocacy groups.

Within this chapter the singular pronouns I and my refer to Michael Merson alone, whereas the plural pronouns we and us generally refer to Michael Merson and Stephen Inrig jointly. Where we or us refers to Michael Merson and his colleagues at WHO, the object of the pronoun is clarified by context.

The original version of this chapter was revised to correct misspellings.

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Notes

  1. 1.

    For the purposes of this text, we will use the term AIDS to encompass both AIDS and HIV unless otherwise specified.

  2. 2.

    Michael Merson, “Report of the Director: Sixth meeting of the Management Committee, Geneva, 23–24 April 1991; Provisional agenda item 3,” Geneva: Global Programme on AIDS, GPA/GMC (1)/91.3; 22 April 1991.

  3. 3.

    Michael Merson, “Report of the Director, Fifth Meeting of the Management Committee, November 26, 1990” Geneva: World Health Organization GPA/GMC (2) 90.3, 1990.

  4. 4.

    Fiona Godlee, “The World Health Organisation: The regions—too much power, too little effect.” BMJ 1994, 10 December, 309:1566–1570; Fiona Godlee, “The World Health Organisation: WHO at country level—a little impact, no strategy,” BMJ 17 December 1994; 309:1636–1639.

  5. 5.

    Michael Merson, “Report of the Director, Sixth Meeting of the Management Committee, April 1991,” Geneva: World Health Organization GPA/GMC; Gill Walt, Interview by Stephen Inrig, Dallas, TX, September 23, 2010.

  6. 6.

    Gary Slutkin, “Global AIDS 1981–1999: The Response [The Pittsfield Lecture],” The International Journal of Tuberculosis and Lung Disease 4, no. 2 (February 1, 2000): S24–33.

  7. 7.

    Gill Walt, Interview by Stephen Inrig, Dallas, TX, September 23, 2010.

  8. 8.

    Michael Merson, “Report of the Director: Sixth meeting of the Management Committee, Geneva, 23–24 April 1991; Provisional agenda item 3,” Geneva: Global Programme on AIDS, GPA/GMC (1)/91.3; 22 April 1991, 16.

  9. 9.

    Michael Merson, “Report of the Director, Fifth Meeting of the Management Committee, November 26, 1990” Geneva: World Health Organization GPA/GMC (2) 90.3, 1990.

  10. 10.

    Ibid.

  11. 11.

    Interim Review Team “Interim Review of Regionalization of GPA Technical Cooperation Activities in the African Region: Provisional agenda item 5; Sixth meeting of the Management Committee, Geneva. 23–24 April, 1991, Geneva: Global Programme on AIDS, GPA/GMC (1)/91.11, 21 March 1991.

  12. 12.

    Global Programme on AIDS, Report of the External Review of the World Health Organization , Global Programme on AIDS, Geneva: World Health Organization, January 1992, p. 13.

  13. 13.

    Mort Rosenblum, “U.N. AIDS-Fighting Agency Having Problems; With AIDS-Losing Battle.” The Associated Press, July 5, 1992.

  14. 14.

    Report of the Seventh Meeting of the Management Committee, 19–21 November, 1991, WHO; Global Programme on AIDS, Report of the External Review of the World Health Organization , Global Programme on AIDS, Geneva: World Health Organization, January 1992, p. 30.

  15. 15.

    Note for the Record, Meeting held with GPA staff on 2 July 1990, GPA reorganization. I based the reorganization on three factors: (1) the priorities of the program as established in its formative documents and approved Global AIDS Strategy; (2) consultations with unit chiefs, regional directors, donor organizations, associated UN agency heads, collaborating researchers, Health Ministers, and other WHO leadership and staff; and (3) the style of management I preferred.

  16. 16.

    Global Programme on AIDS, Proposed Organization Structure, n.d. unpublished document.

  17. 17.

    Ibid.

  18. 18.

    Meetings with Mohammed Abdelmoumene (MA), October 28, 2014, Geneva, Switzerland.

  19. 19.

    Ibid.

  20. 20.

    Jonathan Mann, “Message to Michael Merson,” May 30 1990.

  21. 21.

    Ibid.

  22. 22.

    Letter for Lars Kallings to Michael Merson, May 30, 1990.

  23. 23.

    Note for the Record, Meeting held with GPA staff on 2 July 1990, GPA reorganization.

  24. 24.

    Stefano Bertozzi, Interview by Michael Merson, Cuernavaca, May 15, 2005.

  25. 25.

    Jose Esparza, Interview by Michael Merson Seattle, WA, October, 2001.

  26. 26.

    1991 Progress Report, Global Programme on AIDS, WHO, Geneva; GPA Progress Reports; Global Programme on AIDS, Report of the External Review of the World Health Organization , Global Programme on AIDS, Geneva: World Health Organization, January 1992, p. 9.

  27. 27.

    Michael Merson, “Report of the Director: Sixth meeting of the Management Committee, Geneva, 23–24 April 1991; Provisional agenda item 3,” Geneva: Global Programme on AIDS, GPA/GMC (1)/91.3; 22 April 1991, 16.

  28. 28.

    WHO/GPA Recommended Objectives, Strategies, Interventions and Activity Areas for National AIDS Programmes, 10 April 1991.

  29. 29.

    Michael Merson, “Report of the Director: Sixth meeting of the Management Committee, Geneva, 23–24 April 1991; Provisional agenda item 3,” Geneva: Global Programme on AIDS, GPA/GMC (1)/91.3; 22 April 1991, 16.

  30. 30.

    Michael Merson, “Report of the Director, Fifth Meeting of the Management Committee, November 26, 1990” Geneva: World Health Organization GPA/GMC (2) 90.3, 1990.

  31. 31.

    Michael Merson, “Director’s Report, GPA Management Committee, April 26, 1990,” Geneva: World Health Organization, 1990.

  32. 32.

    Global Programme on AIDS, Report of the External Review of the World Health Organization , Global Programme on AIDS, Geneva: World Health Organization, January 1992, p. 14.

  33. 33.

    “UNAIDS Annual Report 2007”Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS) 2008 UNAIDS/08.21E / JC1535E www.unaids.org/en/media/unaids/contentassets/dataimport/pub/report/2008/jc1535_annual_report07_en.pdf

  34. 34.

    Michael Merson, “Report of the Director: Sixth meeting of the Management Committee, Geneva, 23–24 April 1991; Provisional agenda item 3,” Geneva: Global Programme on AIDS, GPA/GMC (1)/91.3; 22 April 1991, 16.

  35. 35.

    Ibid.; Dr. M.H. Merson, “WHO European Regional Meeting on Psychosocial Aspects of HIV/AIDS and Evaluation of Prevention Strategies” LISBON, 1 JUNE 1990, mhml/l June 1990, 2; Michael Merson, “Report of the Director, Fifth Meeting of the Management Committee, November 26, 1990” Geneva: World Health Organization GPA/GMC (2) 90.3, 1990.

  36. 36.

    Review of experiences in five countries in planning and managing multisectoral AIDS programmes, WHO/GPA GPA/CNP/OSM 10 December 1993.

  37. 37.

    Report of the Study of the Process for NAP Reviews (1989–1993), Global Program on AIDS, Geneva, October 1994.

  38. 38.

    Ibid.

  39. 39.

    Ibid.

  40. 40.

    “Three ONEs” Key Principles. Geneva: UNAIDS, 2004, Conference Paper 1, Washington Consultation 25.04.04; http://data.unaids.org/UNA-docs/Three-Ones_KeyPrinciples_en.pdf

  41. 41.

    World Health Organization, “WHO Global Programme on AIDS 1987–1995: Final Report with Emphasis on 1994–95 Biennium” (Geneva: World Health Organization, May 1997), 23.

  42. 42.

    Preventing HIV Transmission through blood and Blood Products (Including Nosocomial Transmission) WHO/GPA/CNP/93.2 A-E.

  43. 43.

    Guidelines on Costing of Blood Transfusion Services (WHO/GPA/BLS/95.2; Guidelines for Blood Donor Counselling on HIV (WHO/GPA/TCO/HCS/94.2); Recruiting, Educating and Retaining Safe Blood Donors (WHO/GPA/BLS/95.1), pp. 24–25.

  44. 44.

    Michael Merson, “Report of the Director: Sixth meeting of the Management Committee, Geneva, 23–24 April 1991; Provisional agenda item 3,” Geneva: Global Programme on AIDS, GPA/GMC (1)/91.3; 22 April 1991, 32–34.

  45. 45.

    Eric van Praag now serves, at the time of this writing, as the Senior Regional Technical Adviser for FHI 360 living in Tanzania).

  46. 46.

    Provision of HIV/AIDS Care in Resource Constrained Settings (WHO/GPA/TCO/HCS/95.14).

  47. 47.

    Adapting WHO Guidelines for the Clinical Management of HIV Infection to Country Needs” (WHO/GPA/TCO/HCS/94.8). This guideline was field tested in four countries and one subregion (involving 17 countries), representing a spectrum of different drug supply systems, HIV prevalence rates and health services systems; Michael Merson, “Report of the Director: Sixth meeting of the Management Committee, Geneva, 23–24 April 1991; Provisional agenda item 3,” Geneva: Global Programme on AIDS, GPA/GMC (1)/91.3; 22 April 1991, 36.

  48. 48.

    World Health Organization, “WHO Global Programme on AIDS 1987–1995: Final Report with Emphasis on 1994–95 Biennium” (Geneva: World Health Organization, May 1997), 32–34.

  49. 49.

    Ibid., 21–22.

  50. 50.

    The Source Book for HIV/AIDS Counselling Training (WHO/GPA/TCO/HCS/94.9).

  51. 51.

    Counselling for HIV/AIDS: A Key to Caring (WHO/GPA/TCO/HCSI95.15); World Health Organization, “WHO Global Programme on AIDS 1987–1995: Final Report with Emphasis on 1994–95 Biennium” (Geneva: World Health Organization, May 1997), 37.

  52. 52.

    Clinical Aspects of HIV Infection in Adults (GPA/IDS/HCS/93.4); World Health Organization, “WHO Global Programme on AIDS 1987–1995: Final Report with Emphasis on 1994–95 Biennium” (Geneva: World Health Organization, May 1997), 36.

  53. 53.

    “Home and Community Care for Persons with HIV/AIDS” in Lyon (1993) and Montreal (1995); World Health Organization, “WHO Global Programme on AIDS 1987–1995: Final Report with Emphasis on 1994–95 Biennium” (Geneva: World Health Organization, May 1997), 32–34.

  54. 54.

    Michael Merson, “Report of the Director: Sixth meeting of the Management Committee, Geneva, 23–24 April 1991; Provisional agenda item 3,” Geneva: Global Programme on AIDS, GPA/GMC (1)/91.3; 22 April 1991, 16.

  55. 55.

    Jeff O’Malley, Interview by Michael Merson, New Haven, CT, September, 2002.

  56. 56.

    Michael Merson, “Terms of Agreement for launching the International Council of AIDS Service Organizations,” Geneva: World Health Organization, July 19, 1990.

  57. 57.

    Victoria A. Harden, AIDS at 30: A History (Kindle Edition). New York: Potomac Books. Kindle Edition., 2012, Kindle Locations 818–819.

  58. 58.

    1991 Progress Report, Global Programme on AIDS, page 14.

  59. 59.

    WHO AIDS Series: “The Global AIDS Strategy,” Geneva: World Health Organization, 1992. http://whqlibdoc.who.int/aids/WHO_AIDS_11.pdf; Alexander G. Higgins, “World Health Organization Revises Strategy to Meet AIDS Crisis Among Women,” The Associated Press, January 28, 1992. http://www.apnewsarchive.com/1992/World-Health-Organization-Revises-Strategy-to-Meet-AIDS-Crisis-Among-Women/id-d3ce51e17b5544057bfb40e9fdd6f1ce

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Authors and Affiliations

  1. Duke Global Health Institute, Duke University, Durham, NC, USA

    Michael Merson (Wolfgang Joklik Professor of Global Health)

  2. Mount Saint Mary’s University, Los Angeles, CA, USA

    Stephen Inrig (Director, Health Policy and Management Program)

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Merson, M., Inrig, S. (2018). Enhancing Program Delivery. In: The AIDS Pandemic. Springer, Cham. https://doi.org/10.1007/978-3-319-47133-4_9

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  • DOI: https://doi.org/10.1007/978-3-319-47133-4_9

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