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Debrework Zewdie, Former Director of the World Bank Global AIDS Program, and Deputy Executive Director and COO of the Global Fund

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Debrework Zewdie, Former Director of the World Bank Global AIDS Program, and Deputy Executive Director and COO of the Global Fund Harvard School of Public Health | Debrework Zewdie, Former Director of the World Bank Global AIDS Program, and Deputy Executive Director and COO of The Global Fund BEVERLY HO: Good afternoon. My name is Beverly Ho. I'm a physician from the Philippines and a candidate for the master of public health in health policy and management here at the Harvard TH Chan School of Public Health. It is my privilege to welcome all of you today and to introduce Dr. Debrework Zewdie. Her 30 year career in strategy, policy implementation, management, and teaching encompasses national, regional, and global levels. Among the many highlights of her career are her innovative and groundbreaking HIV/AIDS program for the World Bank, her co-leadership and management of the organizational restructuring of the Global Fund to fight AIDS, tuberculosis, and malaria in her capacity as its deputy executive director and chief operating officer, and her instrumental role in making the unique structure of UNAIDS a working reality. By pioneering the call for a large scale multi-sectoral response and subsequently providing direct financing to civil society and the private sector, she changed the landscape of HIV/AIDS financing. Dr. Zewdie's passion for women's health also led her to be a co-founder of the Society of Women and AIDS in Africa. She's a sought after lecturer and public speaker in leading academic institutions and mass media outlets, as well as a thought leader, having published in over 100 journals and book chapters on a variety of subjects. Dr. Zewdie obtained her PhD in clinical immunology from the University of London and was Senior MacArthur Fellow at the Harvard Center for Population and Development Studies. She's currently a Menschel Senior Leadership Fellow at the Harvard TH CHAN School of Public Health. Before I turn the session over to our moderator for the day, Dr. Barry Bloom, Harvard University Distinguished Service Professor, and Joan and Julius Jacobson Professor of Public Health, please join me in welcoming Dr. Debrework Zewdie to the Voices of Leadership Series at the Harvard TH Chan School of Public Health. [APPLAUSE] BARRY BLOOM: Debrework, welcome. It's an enormous pleasure and joy for me to be able to have a conversation with you and have such bright students to be able to listen in to our conversation, and hopefully, people around the world. This is a program that brings to this place people who've exerted real leadership in a variety of areas of health around the world. And perhaps, there's no more fitting conclusion to this first year of Voices in Leadership than to hear from you, to answer for all of us a question that, since I've known you for 25 years, has always been on my mind. How is it that a little girl who was born in a provincial city in Ethiopia managed to create, organize, motivate, run the largest program in health that the World Bank had ever done before that time? And we want to hear about how that happened. But let me just start by asking you to tell us about the experience at the Bank and how one moves this giant male dominated organization. DEBREWORK Thank you, Barry. Both the pleasure and the honor is mine. It's a wonderful institution and teaching brilliant ZEWDIE: students is such a joy. I joined the World Bank in 1994. When I joined the Bank, there were bits and pieces of HIV/AIDS programs, mainly, in health projects. There wasn't anything to scale or something which would-- in my opinion-- would have made a difference. And around 1999, a study, a demographic study, from Botswana came out, which showed that life expectancy due to HIV/AIDS in many of these countries is declining. We used that has an opportunity. Because up to that time, there was a big push, unfortunately, from most of the economists of the Bank who didn't want the bank to get engaged in something long-term, indefinite, and may not be economically cost effective. So when we got that study on the demographic of Botswana, we said, well, is the Bank's business development? Yes. Does development affect life expectancy? Yes. Then we said, so, if that is the case, whatever affects life expectancy should be the Bank's priority. So that's what we used to be get-- we have to develop a strategy. We called it Intensifying Action Against HIV/AIDS-- Responding to a Development Crisis. We had to use that language. Nobody was going to pay attention if we just pitched it as yet another health problem. We had a wonderfully leader-- leaders at the World Bank. Jim Wolfensohn was the president, Callisto Madavo was the vice president of the Africa region, who, when we showed you this life expectancy graphs, said are you telling me that life expectancy in Zimbabwe is what it was when I was an elementary student. We said yes. That made all the difference and open the door for us to put the first billion dollar project for sub-Saharan Africa. BARRY BLOOM: So what follows, naturally, is how did you get there? In the sense that you were put in charge of AIDS, what was your background that enabled you to have the intellectual and scientific qualifications to persuade the economists, a very unusual circumstance? DEBREWORK I started working on HIV/AIDS in Ethiopia. First program, the first cases, it was a very difficult time where aid was ZEWDIE: not coming to Ethiopia from the north. We were socialists, so we had to make do with the little we have to put a surveillance system to protect the blood supply system, primarily, because we didn't know what it was. And from there, I moved to what was known as the AIDS control and prevention program, which was funded by USAID based in FHI and I was based in Nairobi. That gave me an insight to 16 African countries where we had programs. And it's from there, I came to the Bank. When I came to the Bank, it's a formidable institution, brilliant people. They're heart in the right place. They may not always be doing the right things, but an institution which could change the way AIDS was ravaging sub-Saharan Africa. So I was waiting for that opening. Incidentally, nobody does anything by one's self. It's a group effort. It's all circumstances, leadership, people below you who work on this. So I'm not going to claim the whole team as if I did it by myself. So I had seen the epidemic, I had seen what it is doing to sub-Saharan Africa, I had also seen the reluctance on the part of the governments of Africa to either use their own resources or seek help. This was something that they didn't want to touch. At the same time, we would go on a mission to a country, it could be any education mission or health mission, you go back after three months, your counterparts have died. So this was a reality which was happening in Africa then. And I had a belief that if anybody could do anything substantive, it's would be the World Bank, because there wasn't a Global Fund, there wasn't PEPFAR then. And the way to do it was to sensitize the decision makers in the Bank, so that they give us this. I organized a two day seminar. In fact, Harvey Fineberg came from here. The first day, we looked at the evidence, the science, the epidemiology. The second day was a policy meeting, where we had the leaders of the bank listen to this. Then we were given a go ahead to come up with a concept, which we did. And we wrote it in a very different way, the normal Bank instrument was not going to do it for us because it takes anywhere from 18 to 36 months from concept to board approval. There was a small instrument which was created to deal with an emergency for hurricane in the Caribbean Islands. We took that instrument and it was fast, it was on an emergency basis, it didn't ask a whole lot of things from the countries, which they take months to prepare. What we added to it was, again, something which was not usual at the bank, we said here we are, the drugs are very expensive, but there is a lot of care and a lot of prevention which is being taken care of by civil society organizations, religious organizations. So we needed an instrument which allowed us to channel resources to these unusual group for the World Bank. They agreed to the timeline. They agreed to money being channeled directly to civil society organizations. And they gave us $1 billion. BARRY BLOOM: How could anyone imagine turning Debrework down with making such a case? DEBREWORK Yeah, I have a lot of charm. ZEWDIE: BARRY BLOOM: Tell us a little bit about your training. You're not trained in economics, and yet you've had a powerful role in the most important economic institution in the world. How did you come to get into the AIDS business? DEBREWORK Clinical immunology, a good segue to get into HIV/AIDS, but when I was in Ethiopia, I was working in a research ZEWDIE: institution, but participating in the national HIV/AIDS control program. At one point, I was instructed by the government to take over the national AIDS control program.
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