What next for the Global Fund?
Money, money, money but why is not enough going to the Global Fund?
Hi there. It’s just me today. I hope that’s not too much of a disappointment after all of the fantastic entries we had from around the world yesterday!
Today, I just want to draw your attention to an editorial in this month’s The Lancet Infectious Diseases (TLID) on the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund has had a bit of stick recently and as you probably know, many donors failed to meet their pledges at the recent donor meeting in Berlin. But there is also a bit of chatter around about extending the role of the Global Fund so that it is more than just a fund for the big three. This was mentioned at the Women Deliver Conference last week as Rafi Rogans-Watson mentioned in one of his reports.
I think we will be hearing a lot more about the future plans for the Global Fund in the weeks and months to come but for now, here is the leader from TLID which discusses the current situation. Enjoy! Rhona 
The Global Fund: Growing pains
The sound bites and spin coming from the latest replenishment round of the Global Fund to Fight AIDS, Tuberculosis and Malaria have done little to evoke confidence in the Fund’s future support. Despite positive press statements from the Global Fund and donor governments at the recent donor replenishment meeting-rather cruelly known as the begging round-in Berlin (Sept 26-28), many governments pledged substantially less than they had previously committed to. But there is no time to brood. Next comes the round 7 meeting (Nov 11-13) where the Global Fund will examine funding proposals for the coming year.
By contrast with the enthusiasm from donors 5 years ago when the Global Fund was founded, the current lack of support is disappointing-and dangerously short sighted. In just a few years, the Global Fund has established itself as the major player in the fight against the “big three” infectious diseases. For example, it currently funds through its grants programme 20% of the HIV programmes in the world, constituting about 60% of its own budget. To date, programmes supported by the Global Fund have provided treatment for 1·1 million people living with HIV/AIDS and 2·8 million people with tuberculosis. According to the Fund’s own estimations, these programmes have averted 2 million deaths worldwide. So in light of all this life-saving work, donor apathy is unacceptable.
However, it is easy to be distracted by the Global Fund’s financial worries and there are other key factors at play that may limit its effectiveness. Although the Global Fund’s remit has always been clear, and its organisational principles are impressive, from its conception the Global Fund was set up as a financial instrument, not an implementation agency. Its aim was to raise and give additional resources for the treatment of HIV/AIDS, tuberculosis, and malaria-according to former UN Secretary General Kofi Annan, it was to be a war chest. The Global Fund would operate transparently and administer funds through a rapid performance-based grant process. Crucially, it would support country-led plans and priorities, form innovative public-private partnerships, and thereby support people and communities living with these diseases. These principles and its focus on the big three has made it unique among international institutions.
Yet despite its best efforts to remain true to its founding principles, the Global Fund has learned through experience that putting these principles into practice is fraught with difficulty. Furthermore, many believe that its tight remit is increasingly becoming a straight jacket. Considerable criticism has been directed at the Global Fund’s narrow disease-specific approach by civil society groups and others; an approach which many say distorts comprehensive health planning and diverts resources from other diseases and priorities (for example, other sexually transmitted infections), and which does not contribute to overall health-system strengthening. In response, the Global Fund implemented a stand-alone grant application process for health-system strengthening in 2005. However, after complaints from donors that this should not be an activity of the Global Fund, rather than fighting its corner, this grant scheme was subsequently stopped. Nevertheless, for the current funding round, guidelines state that applicants can request funds for health-system strengthening if these activities are essential to reducing the impact and spread of HIV/AIDS, tuberculosis, or malaria. This is a welcome step-it shows that the Global Fund is ready to take more of a whole-systems approach that will help make a long and lasting impact on the burden of infectious diseases in resource-poor countries.
Yet there is the opportunity to do more in the seventh round talks and the Global Fund must once again be bold enough to expand its remit. Recommendations made by civil society groups to the Global Fund board have called for institutional support for integrating sexual and reproductive health interventions into HIV/AIDS programmes. The Global Fund has supported very few applications for sexual and reproductive health interventions and has turned down requests for funding for sexual infections other than HIV/AIDS. Several countries have now submitted proposal requests that include such integration. For example, Rwanda has proposed to incorporate gender-based violence, a major driver of the HIV/AIDS pandemic, as an element of its sexual and reproductive health services.
The only sound public health and human rights approach for the Global Fund to take is to start dealing with the wider factors involved in tackling the big three. Expanding its remit to include a greater focus on the wider issues would be the right thing to do. It is time for the Global Fund to rise to the challenge. The Lancet Infectious Diseases
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