The Global Fund’s Business Model
At the time of its creation, the Global Fund was part of a new breed of players in global health global health initiatives which rely on a common blueprint or strategy that is implemented across a range of countries to target a specific disease, group of diseases or global health challenge. The GHIs vary widely in focus and institutional model. However, as innovative mechanisms, GHIs all share the aim of addressing a major health issue across different countries. Some GHIs notably the US President’s Emergency Plan for AIDS Relief are bilateral, but GHIs are often seen as an opportunity to combine the skills and resources of traditional multilateral organisations, such as the World Health Organization , United Nations Children’s Fund and World Bank, with bilateral agencies and the private sector in order to utilise the energy and country-level experiences of non-governmental organisations .4,5
The Global Fund To Fight Aids Tuberculosis And Malaria
|Focus||Accelerating the end of AIDS, tuberculosis and malaria as epidemics|
The Global Fund to Fight AIDS, Tuberculosis and Malaria is an international financing and partnership organization that aims to “attract, leverage and invest additional resources to end the epidemics of HIV/AIDS, tuberculosis and malaria to support attainment of the Sustainable Development Goals established by the United Nations“. This multistakeholderinternational organization maintains its secretariat in Geneva, Switzerland. The organization began operations in January 2002.Microsoft founder Bill Gates was one of the first donors to provide seed money for the partnership. From January 2006 it has benefited from certain US Privileges, Exemptions, and Immunities under executive order 13395, which conferred International Organizations Immunities Act status on it.
The Global Fund is the world’s largest financier of AIDS, TB, and malaria prevention, treatment, and care programs. As of June 2019, the organization had disbursed more than US$41.6 billion to support these programs. According to the organization, in 2018 it helped finance the distribution of 131 million insecticide-treated nets to combat malaria, provided anti-tuberculosis treatment for 5.3 million people, supported 18.9 million people on antiretroviral therapy for AIDS, and since its founding saved 32 million lives worldwide.
How Has The Global Fund Affected The Fight Against Aids Tuberculosis And Malaria
The Global Fund to Fight AIDS, Tuberculosis and Malariaone of the most important vehicles for delivering life-saving drugs and treatment to the worlds poorhas virtually transformed public health delivery in its four short years of existence. Unfortunately, in spite of its successit currently has disbursed nearly $3 billion for 371 projects in 129 nationsfull funding has not yet been pledged .
The success of the fund largely derives from its operational strategy: it serves as a financial donor but not advisor to countries health programs. It is indeed an innovative approach because recipients drive the planning and implementation process. The fund-supported programs are thus tailored to local needs, benefit from the enthusiasm and commitment that comes with a sense of ownership, and help build the managerial expertise and institutional capacity necessary for improving national health care systems.
Unlike the heavy-handed programs of the past, the fund finances projects that tend to be led by government or nongovernmental organizations. The onus is thus on them, not the fund, to deliver results. The fund supports programs that focus on performance by linking resources to the achievement of clear, measurable and sustainable results . From the funds genesis, it was made clear that when the time came to renew grants, grantees not producing sufficient positive results would not receive additional funds .
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V What The Global Fund Supports
The Global Fund provides grants in HIV/AIDS, tuberculosis, malaria and health systems strengthening to low- and middle-income countries. The Country Coordinating Mechanism submits the proposal, based on a country-led needs analysis the Global Fund does not prescribe or recommend any specific programs. Countries are encouraged to write cost-effective, and practical national plans, from which the proposals should be drawn. Frequently, consultants help countries to write the proposals, which are long and quite complicated.
Within the specific disease components, the Fund will accept proposals for a wide variety of activities, including prevention, care and treatment. Organizations eligible for funding are government agencies, NGOs and the private sector. Although government agencies are the most common recipients of funding, there are several very successful grants managed and implemented by non-governmental or private sector organizations. However, all proposals, irrespective of Principal Recipients must be submitted with broad, multi-sectoral support in the country, and all proposals are submitted by the CCM. Non-CCM proposals are extremely rare and generally limited to cases of civil war and similar internal strife. Proposals that do not show this buy-in are not considered for funding.
Coverage Of Treatment And Prevention Interventions
Malaria coverage calculated based on 38 African countries for which data is available from WHO / Malaria Atlas Project estimates in countries where the Global Fund invests. HIV and TB estimates are based on all countries where the Global Fund invests. Based on data from WHO and UNAIDS .
We measure our progress against the targets in the global plans for HIV, tuberculosis and malaria and in Sustainable Development Goal 3: Health and well-being for all.
That achievement is the result of efforts by a wide array of actors comprising the Global Fund partnership, including governments, multilateral agencies, bilateral partners, civil society groups, people affected by the diseases, and the private sector.
Peter Sands, Executive Director of the Global Fund
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Malaria By The Numbers:
- The Global Fund provides 56% of all international financing for malaria programs.
- We have invested more than US$16 billion in malaria control programs as of April 2022.
- Since January 2021, we have increased malaria grants by 23% on average.
- 188 million insecticide-treated nets distributed to protect families from malaria in 2020.
- 9.4 million structures covered by indoor residual spraying in 2020.
- 30 million children covered by seasonal malaria chemoprevention in 2020.
- 11.5 million pregnant women received preventive therapy in 2020.
Testing and Treatment
- 259 million suspected cases tested for malaria in 2020.
- 135 million cases of malaria treated in 2020.
Why The Global Fund Is Good For The World
Many Global Fund programs are meeting or exceeding their targetsprograms in countries like China, Ghana, Honduras and Rwanda reached 80 percent of their original two-year goals during their first years of operation . Depending on how one judges, anywhere from one-quarter to one-half of Global Fund recipients have met or exceeded the ambitious goals they set for themselves. And even a 25-percent success rate would be staggering, considering the troubling history of public health endeavors in poor countries. Many of the recipients are worthy of renewed financial support. Sadly, an increase in their funding is not guaranteed.
The primary difference between the successful Global Fund programs and other deserving but underperforming programs is that those in the former group operate in countries where health care systems are already in place. They have hospitals and doctors and competent health ministries they have mechanisms for running public education campaigns, for setting up testing clinics, for delivering medication to patients. For these countries, the infusion of significant Global Fund money is precisely the key to finally beating AIDS, tuberculosis and malaria. In the less fortunate countries, however, money isnt enough. Without the expertise and the health systems, the millions of dollars are not spent effectivelyand in many cases may not be spent at all.
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Sweden Invests In Global Health With Record Financial Support To The Global Fund To Fight Aids Tuberculosis And Malaria
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On 13 July, the Government of Sweden announced its plan to increase its financial support to the Global Fund to Fight AIDS, Tuberculosis and Malaria to SEK 3 billion over the next three-year period. Swedens support will contribute to the funds goal of saving 20 million lives and reducing mortality from HIV and AIDS, tuberculosis, and malaria by two-thirds.
Since its inception 20 years ago, the Global Fund to Fight AIDS, Tuberculosis and Malaria has helped save more than 40 million lives in more than one hundred countries and contributed to strengthening health systems and building capacity to deal with health emergencies such as COVID-19. After several years of positive trends, the COVID 19 pandemic and Russias aggression against Ukraine have severely disrupted the work against HIV, tuberculosis and malaria. Each year, close to three million people lose their lives to these diseases. For this reason, the Government of Sweden plans to increase its financial support to the Global Fund to SEK 1 billion per year from 2023 to 2025. This represents an increase of over five per cent of Swedens financial support.
Press Secretary to the Minister for Foreign Trade and Nordic Affairs Anna HallbergPhone Mobile +46 73 042 21 84email to Tobias Eke Vestergren
Why Is It Important
- Ending the epidemics of HIV, TB, and malaria is critical to the development of effective health systems that can deliver health and well-being for all.
- Since 2002, the Global Fund has disbursed more than $45.4 billion toward the fight against HIV/AIDS, TB, and malaria and for programs to strengthen health systems across more than 155 countries.
- Health programs supported by the Global Fund have saved 38 million lives as of the end of 2019.
- In 2019, the Global Fund provided 20.1 million people antiretroviral therapy for HIV, treated 5.7 million people with TB, and distributed 160 million mosquito nets.
- AIDS, TB, and malaria claim more than 5 million lives annually.
- 7,000 adolescent girls and young women are infected with HIV every week.
- Multidrug-resistant TB is on the risenearly 600,000 people were afflicted worldwide in 2017.
- Globally, only half of the MDR-TB patients who initiate treatment are successfully treated, mostly due to high mortality and falling out of treatment programs.
Health programs supported by the Global Fund have saved 38 million lives as of the end of 2019.
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The Global Fund & Covid
Since the beginning of the pandemic, the Global Fund has acted to support countries in their efforts to address COVID-19s impact on HIV, TB, and malaria programs. The Global Fund established a COVID-19 Response Mechanism 28 in April 2020, and also has allowed for grant flexibilities that give countries the ability to use a certain percentage of their current grants for COVID-19 response activities. As of October 2021, the Global Fund had awarded over $4 billion in funding to more than 100 countries to support countries responses to COVID-19.29 Support from the Global Fund to countries has been used to:
The Global Fund is also a founding partner of the Access to COVID-19 Tools Accelerator , a global partnership working to accelerate the development, production, and equitable distribution of COVID-19 tests, treatments, and vaccines. The ACT-Accelerator is organized into pillars of work: Diagnostics, Therapeutics, Vaccines, Health Systems Connector, and Access & Allocation.30 The Global Fund co-leads two of these pillars the Diagnostics Pillar and Health Systems Connector and supports procurement and distribution for the Therapeutics Pillar.31
Iii Structure Of The Global Fund
The Global Fund has established a unique architecture under which programs are proposed, selected, managed and implemented at country and headquarters levels.
a.SecretariatBecause the Global Fund is a financing mechanism and not an implementing agency, the institution has no direct presence in recipient countries. Global Fund operations are managed by a lean staff of approximately 200 people based in Geneva, Switzerland. Executive Director Richard Feachem manages the Secretariat. He announced in March 2006 that he would not seek a third term and a new executive director is expected to be appointed in the near future.
The key structures of the Secretariat are Operations , Strategic Information and Evaluation, Business Services, External Relations, and Board Relations. An Office of the Inspector General was also recently added. For more information on the roles and responsibilities, see: .
c. Technical Review PanelThe technical review panel is an independent group of approximately 26 experts drawn from around the world who review all proposals for Global Fund grants and rate them on technical merits. This panel is appointed by the Board of Directors before each round of proposals is due. The Technical Review Panel makes recommendations to the Board of Directors about which proposals should be approved, which should be revised and which should be rejected.
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Tb Trends In Deaths And Cases
In countries where the Global Fund invests, TB deaths since the Global Fund was founded in 2002 have been reduced by 21% as of 2020. But as the COVID-19 pandemic continues, it is unclear if the decrease in testing and treatment services experienced in 2020 will lead to increased deaths and infections.
Trends in TB deaths
Trends in new TB cases
TB burden estimates from WHO Global TB Report 2021. Estimation of no TB control trends for TB deaths from WHO and for new TB cases based on the assumption of constant trend in new TB cases since 2000. While major control efforts for malaria and HIV began with the launch of the Millennium Development Goals in 2000, TB control efforts began much earlier. The counter-factual and actual results therefore diverged from each other much earlier, making this graph look considerably different than its HIV and malaria counterparts. Global Fund portfolio indicates countries where the Global Fund invests. Impact is assumed to be zero if the actual estimates exceed the counterfactual.
Ii History And Founding Principles
Initial discussions on the creation of the Global Fund were held in 2000 and 2001. After the G-8 Heads of State meeting in Okinawa, Japan, in 2000, called for the creation of a Fund, African leaders meeting in Abuja in 2001 voiced support, as did United Nations Secretary General Kofi Annan. The United Nations Special Session on AIDS, in June 2001, called for the formal creation of the Global Fund. A transitional working group was then formed to establish its structures, and the Secretariat opened its doors in Geneva in January 2002. The first grants were made in March 2002.
Backers of the new fund agreed at its inception that experts and countries knew how to scale up prevention and treatment programs for HIV/AIDS, tuberculosis, and malaria, provided that funds were available. They viewed existing aid programs as inadequate and incapable of scaling up quickly enough to meet pressing needs. They sought to create a new mechanism that would be leaner, faster, and more “business oriented”. The Global Fund was meant to add to, not duplicate, existing aid and global health institutions including the World Health Organization and UNAIDS. These institutions remain intimately involved in Global Fund activities, providing technical expertise and on-the-ground experience.
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Viii Analyses Of The Global Fund
The Global Fund provides a wealth of information on its website, and has been very receptive to research and reflection on its model of aid delivery. Consequently, there have been many analyses conducted on the Global Fund during its four years. Several analyses are specific to certain aspects of the Fund architecture, such as CCMs, LFAs, or private sector involvement. The analyses listed below are more general in nature. Additional analyses can be found on the Global Fund website or on the Aidspan website.
Us Engagement With The Global Fund
In addition to U.S. governance and oversight of the Global Fund, U.S. financial support has been significant and a key component of U.S. involvement .20 The U.S. first contributed to the Global Fund in FY 2001 through annual appropriations bills.21 All U.S. support for the Global Fund was then incorporated into PEPFAR when it was created in 2003.22 At that time, Congress authorized up to $1 billion for the Global Fund for FY 2004 and such sums as may be necessary for FY 2005-2008.23 In the 2008 reauthorization of PEPFAR, Congress authorized up to $2 billion in FY 2009 and such sums as may be necessary for FY 2010-2013.24 In 2013 and 2018, Congress again reauthorized PEPFAR, and while it included provisions on U.S. support for the Global Fund , it did not include specific funding amounts.25 See the KFF brief of PEPFAR reauthorization.
Congress specifies support for the Global Fund each year as part of PEPFAR appropriations, and funding is typically provided through the Department of State, although funding has also been provided through USAID and NIH in past years. Between FY 2001 and FY 2021, regular Congressional appropriations to the Global Fund totaled $21 billion. In FY 2021, an additional $3.5 billion was provided as emergency funding to respond to the COVID-19 pandemic.26 Congress has historically matched or provided more to the Global Fund each year than the President has requested.
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