The Global Fund to Fight AIDS, Tuberculosis and Malaria

UN-Coordinated Funding Mechanism Central to Global AIDS Fight

Global-Fund.jpg
Image Credit: The Global Fund

The Global Fund to Fight AIDS, Tuberculosis, and Malaria (also known as "The Global Fund" or, simply, "The Fund") is a global health agency that attracts and disburses resources to prevent and treat HIV , tuberculosis, and malaria in low- to medium-income countries.

History of The Global Fund

Based in Geneva, The Global Fund was founded in 2002 after nearly two years of policy and operational discussions between key stakeholders—including multilateral agencies, non-governmental organizations (NGOs), G8 nations, and non-G8 nations.

United Nations Secretary Kofi Annan made the first private donation to the Fund back in 2001, followed by the Olympic Committee who matched Annan’s contribution of $100,000. Soon after, the Bill & Melinda Gates Foundation committed seed capital in the amount of $100 million, while the U.S., Japan, and Britain each pledged $200 million in the initial round of funding.

While only $1.9 billion had been pledged at the time of the Fund’s launch—well short of the $7 to $10 billion proposed by Annan —increasing commitment from leading developed countries resulted in a rapid upswing in support. By 2012, the Fund's 10th anniversary, $30 billion had been raised, with approximately $22 billion dispersed.

Among private sector donors, the Gates Foundation, (RED), and Chevron are today among the largest contributors, with commitments up to 2020 totaling $2.25 billion, $600 million, and $60 million, respectively.

The sixth replenishment of The Global Fund for 2020-2022 accrued pledges in the amount of $14.02 billion—a record amount for a multilateral health organization, but still shy of the $15 billion sought (or the $26 billion that the UN estimates is needed each year to fight AIDS alone).

How the Global Fund Works

The Global Fund acts as a financing mechanism rather than as an implementation agency (in contrast to PEPFAR, which has traditionally coordinated and implemented HIV/AIDS activities through multiple U.S. channels).

The Global Fund Board—comprised of donor and recipient nations, as well as private and multilateral organizations—is responsible for setting policy, outlining strategies, and establishing both funding criteria and budgets. 

Programs are implemented within each recipient country by a committee of local stakeholders who comprise what is called the Country Coordinating Mechanism (CCM). The Global Fund Secretariat is responsible for grant approval and disbursement to CCM, as well as the monitoring and evaluation of program efficacy.

Grants are entirely performance-based and issued to a Principal Recipient (PR) designated by the CCM. Local Fund Agents (LFAs) are contracted regional to oversee and report back on grant performance.

Based upon these measures, the Secretariat can decide whether to issue, revise, withhold, or discontinue funding to the CCM. Grants are approved for an initial period of two years and renewed for three, with funds dispersed every 3-6 months. 

Achievements and Challenges

The Global Fund supports programs in more than 140 countries and, together with PEPFAR, is one of the primary international financiers of HIV prevention and treatment services worldwide.

Among its 2019 achievements, the Fund is credited with placing over 18.9 million HIV-positive people on antiretrovirals (ARVs), treating 5.3 million people with TB, and distributing over 131 million long-lasting insecticidal nets to prevent malaria.

As a result of these and other programs, deaths due to TB, HIV, and malaria have plummeted. Between 2000 and 2018, the number of TB deaths decreased by approximately 29%. Between 2000 and 2019, HIV-related deaths around the world decreased by 51%. Malaria deaths also dropped 48% between 2000 and 2015.

Yet despite these advances, UNAIDS estimates that ARV coverage stands at just 33% globally, with approximately 12.6 million people still in need of treatment. Moreover, as new infections and AIDS-related deaths continue to decline, even more people will need to be placed on lifelong ARVs, further impacting an already stretched budget.

In response to these challenges, The Global Fund issued a strategic proposal in 2012 whereby greater funding emphasis would be placed on sustainable, high-impact programs with proven, strong value for dollar.

Controversies and Criticisms

While The Global Fund’s "hands-off" policy is credited with reducing bureaucracy and streamlining the scaling of programs within recipient countries, some have criticized the agency for failing to prevent the corruption and squandering of funds by a number of controversial CCMs. 

For example, in 2002, The Global Fund earmarked £48 million for a provincial project in the KwaZulu Natal, South Africa. The aim was to fund the program directly in an effort to sidestep the government of President Thabo Mbeki, who had repeatedly proclaimed that antiretrovirals were more toxic than HIV. In the end, The Global Fund ceded the funds to the Mbeki government—the designated CCM—despite efforts by Mbeki and his health minister to block the distribution of ARVs to pregnant women.

Later in 2011, the Associated Press (AP) reported that up to $34 million in funds had been lost to corruption, with abuses running as far as Mali, Uganda, Zimbabwe, Philippines, and Ukraine. During investigations, the U.N. Development Fund (UNDP) attempted to block The Global Fund inspector general from accessing internal audits in some 20 different countries, claiming diplomatic immunity.

(In an op-ed published in the Washington Post, columnist Michael Gerson refuted the AP claims by asserting that the lost funds represented a mere two-thirds of 1% of the total monies distributed by The Global Fund.)

In that same year, the Fund was forced to cancel the eleventh round of grant renewals due to unmet or delayed pledges by donor countries. In fact, a number of countries, including Germany and Sweden, had purposely withheld contributions due to numerous claims of "waste, fraud and corruption," while a number of organizations called for the resignation of the Fund's then-Executive Director, Michel Kazatchkine.

In the wake of these and other controversies, The Global Fund Board accepted the resignation of Kazatchkine in 2012 and implemented immediate changes to its strategic model—asserting a more active role in grant management, while placing greater emphasis on, its own words, "the highest-impact countries, interventions and populations."

Dr. Mark R. Dybul, who had previously served as the U.S. Global AIDS Coordinator under PEPFAR, took over as Executive Director from in November 2012. Banker Peter Sands became the Executive Director in March 2018.

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