The Global Fund to Fight AIDS, Tuberculosis and Malaria

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is a multi-billion dollar international financing mechanism that aims to increase the availability of funding by directing money towards areas of greatest need. The organisation works as a partnership between governments, civil society, the private sector (including businesses and foundations) and affected communities by combining resources towards fighting HIV and AIDS, Tuberculosis and Malaria through grant programmes.

The official aim of the Global Fund is to:

“attract, manage and disburse additional resources through a new public-private partnership that will make a sustainable and significant contribution to he reduction of infections, illnesses and deaths, thereby mitigating the impact caused by HIV/AIDS, tuberculosis and Malaria in countries in need and contributing to poverty reduction as part of the Millennium Development goals."¹

In January 2000 at the G8 conference in Okinawa, Japan, it was recognised that there was a need for greater resources to fight AIDS, tuberculosis and Malaria.² This recognition was further supported by the United Nations (UN) former Secretary-General, Kofi Annan in 2001³ and contributed to the Global Fund’s foundation in January 2002 in Geneva, Switzerland. Just three months later, the grant board approved the first round of grants for 36 countries.

back to top How is the Global Fund run?

The day-to-day running of the Global Fund is carried out by the Secretariat, which consists of 5 departments, including the Corporate Service, Finance, Country Programmes, External Relations and Partnerships, and Strategy, Performance and Evaluation. The Secretariat has the responsibility of the day-to-day operation including mobilising resources from the public and private sectors, managing grants, providing financial, legal and administrative support and reporting information on the Global Funds activities to the Board and general public. It consists of approximately 470 employees representing more than 89 nationalities and makes up 5% of the total annual expenditures. The Global Fund’s Executive Director, Professor Michel Kazatchkine, who replaced the Fund’s first Executive Director, Sir Richard Feachem, in April 2007, oversees the Secretariat.

An international Board of 20 voting members consisting of 3 ‘blocs’⁴ and 6 non-voting members governs the issuing of grants.

In addition, there are 6 advisory committees who are periodically assigned tasks to research by the Board.

The Technical Review Panel (TRP), which exists to review grant applications made by recipient countries, also assists the Board. The TRP is made up of an independent panel of health experts who thoroughly examine the technical merits of every application. They can then propose to the Board that a grant application is approved without any conditions, this it is approved with conditions, that it is re-written and resubmitted, or that it is rejected altogether.

The current chairperson of the Global Fund’s Board is Dr. Tedros Adhanom Ghebreyesus, Health Minister of Ethiopia, who replaced Mr, Rajat Gupta in July 2009. The vice-chair - Dr. Ernest Loevinsohn, replaced Mrs Elizabeth Mataka in July 2009. Dr Loevinsohn is also Director General of the Global Initiatives Directorate of the Canadian International Development Agency.⁵ The Chairperson alternates between an expert from a donor country and one from a recipient country every two years.

The Board is dedicated to operate by consensus and in the spirit of partnership. However, when this is not achievable, a two-thirds majority can pass motions.

back to top The Global Fund board

back to top Who gives money to the Global Fund?

Around fifty countries have pledged money so far to the Global Fund. Many of these are wealthy western or middle-eastern nations, although pledges have also been received from countries directly affected by AIDS, TB and Malaria. Uganda for example has pledged $2,000,000 to the Fund, while Burkina Faso has given $75,000. The biggest single donor country is the US, whose donations make up around 33% of the funds pledged every year. In 2009 the United States government set a record by announcing it would make a contribution of $ 1.05 billion for the 2010 financial year, the highest amount ever pledged to the Global Fund by the US.⁶

“The biggest single donor country is the US, whose donations make up around 33% of the funds pledged every year.”

As well as national governments, contributions to the Global Fund also come from large organisations (such as the International Olympic Committee and the Bill and Melinda Gates Foundation), from individuals (Kofi Annan has personally donated $100,000), from private sector partnerships, such as (PRODUCT)RED and from fundraising events - a Real Madrid Soccer Match held in 2002 raised a grand total of $112,487.

Essentially anyone can donate to the Fund. More information about how to do this can be found on the GFATM's donations page.

How does the Global Fund secure government donations?

The board of the Global Fund does not dictate who should donate money nor how much should be donated, but it does issue guidelines on how much will be needed to maintain funding and approve new grants. Major developed countries are expected to meet a proportion of this estimate dependent on their GDP, though pledges are essentially made on a 'goodwill' basis (with the obvious political kudos that this may bring). This allows the funding level estimates to be increased in the event of an emergency.

The Global Fund also now has a system based on regular periodic replenishments, which enables more accurate forecasting of available resources over the coming years. This replaces a more 'ad hoc' and flexible system of replenishment that was used in the early years to attract new donors who may otherwise have been wary about committing large sums to an untested scheme. To implement the new system, special 'replenishment conferences' are now held on a regular basis, facilitating debate about the Global Fund's needs and encouraging potential new donors to enter into discussion and offer pledges.

How does the 'regular' replenishment mechanism work?

The regular replenishment mechanism works by establishing regular meetings that allow donors to discuss and negotiate current funding needs for a set period, both with the Global Fund board, and with their fellow donor nations.

In the early years of the Fund's operation, pledges were not made to any set schedule. In the first year of the Fund's operation, most countries pledged a large amount sufficient for several years of funding. Any extra resources that were necessary were then negotiated on an ad-hoc basis. However, this method eventually led to the appearance of funding gaps (where the amount of money held by the Fund was less than the total needed to fully finance grants), so in 2005, a new system was implemented. The first three "Voluntary Replenishment Conferences" were held in Stockholm, Rome and London. These conferences enabled donors to see the extent to which the Fund would need to be replenished in 2006 and 2007, and pitch their pledges accordingly. Donations for 2008 and beyond were negotiated in three similar meetings in 2007.

Why do wealthy countries not donate more money?

Just as nations have their own unique way of regulating trade to benefit their economy, so each developed country will have its own agenda when it comes to funding aid programmes. This is why most donors will fund their own bilateral (country-to-country) aid programmes for AIDS, TB and Malaria alongside their Global Fund donations.

The US has pressurised the Global Fund to bring its policies in line with the Bush Administration's sensibilities in the past, but with little success.

In the UK, a lot of health-related development funding goes out via bilateral programmes established by the Department for International Development (DfID) In the USA, PEPFAR is the preferred vehicle for funding overseas HIV prevention and treatment programmes. One of the main rules about pledging to the GFATM is that this money comes with 'no strings attached'. That means that countries and organisations cannot dictate where their money goes - they have to be willing for it to be used for any purpose and in any country where it is needed. As the previous US government strongly objected to harm reduction strategies amongst drug users, and other programmes that it saw as 'endorsing' prostitution or abortion (all of which may be funded by the GFATM), a national scheme that does not support such initiatives was seen as a preferable recipient of federal funds.

Another problem lies in the way that funding is shared out between wealthy nations. While the US has increased donations to the Global Fund every year since 2005, Congress has insisted that this amount is capped at 33% of the overall total of pledges received (33% being the US percentage of global GDP).⁷ This means that if other countries give less, theoretically so does the US.

back to top Other sources of funding

(PRODUCT) Red

(PRODUCT)^RED is an initiative that was launched by the singer Bono in the UK in January 2006, and in the USA in October 2006. Its aim is to engage various commercial partners by getting them to theme some of their products with special Global Fund (RED) branding. A proportion of the proceeds from sales of these items then goes to combat HIV and AIDS in several selected countries being supported by the Global Fund. So far, Emporio Armani, GAP, Converse, Apple, Hallmark, Motorola, Dell, Bugaboo and Microsoft have all signed up to the scheme, and American Express has launched a (RED) credit card that donates 1% of the value of all purchases to the Fund.⁸ . Profits from the sale of several special UK (RED) Independent newspapers, one edited by Bono himself, have also gone to the Fund, and a (RED) edition of the medical journal The Lancet was produced in August 2006⁹ (See our AIDS History 2003 - 2006 page for more).

By 2008, (PRODUCT)^RED had claimed to have generated more than US $ 100 million for the Global Fund with 100% of that money going towards grants for Lesotho, Rwanda, Swaziland and Ghana.¹⁰ In February 2008, an art auction at Sothebys in New York raised US $42 million for (RED) in a single day, taking the total to more than US $100 million.¹¹

Despite this moderate success, the scheme has proved controversial, with some saying that the percentage of (RED) profits that actually go to the Global Fund is too small. Others have criticised the amount spent on promoting (RED) - as early as March 2007, some estimated that the advertising outlay had already reached US $100 million.¹² An organisation - BUY (LESS) - has since been set up to discourage people from seeing shopping as the answer to the world's problems, and to encourage direct giving as a preferable solution.¹³

What is Debt2Health?

Debt2Health is a scheme whereby poor country debts will be cancelled, providing the government of that country agrees to invest the money saved in Global Fund health programmes.¹⁴ The programme is still in its infancy, but the German government has already agreed to cancel a € 50 million worth of debt owed by Indonesia, providing the country invests half of this in domestic Global Fund programmes.¹⁵ Germany has also agreed to write off € 40 million of Pakistan's debt on condition that Pakistan invests € 20 million in domestic health programmes supported by the Global Fund.

back to top How is the money distributed?

Over 120 different nations, from Afghanistan to Zimbabwe, have benefited (or will benefit) from Global Fund money. The full list along with detailed progress reports can be found on the Global Fund website. In the round of grants approved in November 2007 about 57% of the money was planned to go to sub-Saharan African nations, 12% to East Asia and the Pacific, 9% to Eastern European and Central Asian Countries, 8% to Latin America and the Caribbean, 8% to South Asia and 6% to the Middle East and North Africa.¹⁶

How do these countries gain access to funding?

To receive money, a country's government (or even an individual organisation) will need to make a grant application. The GFATM has a policy of only giving money to those who apply for it, unlike some other funding programmes (such as the American PEPFAR scheme) who actively seek out suitable recipients and offer them money. This means that in theory, funding is available to anyone that needs it. The only restriction the Fund has is the amount of money available in their central bank account. There are for example no 'quotas' as such on how much money is spent on each disease - this is governed strictly by need, allowing greater flexibility in tackling the most urgent crises. In round 7, around 61% of funding was being spent on HIV and AIDS, 25% was being used to fight Malaria and 14% was going on Tuberculosis programmes.¹⁷

An important part of any country's funding application process is the negotiations that take place with their Country Coordinating Mechanism (CCM). In every country that wishes to receive funding from the Global Fund, a CCM will be set up to help organise and submit grant applications to the Fund and monitor their implementation. A CCM will generally be made up of a broad range of representatives from government agencies, NGOs (Non-Governmental Organisations), local community and faith-based organisations, individuals working in the field and private sector institutions.

When the grant is approved and the money arrives, it is given to the Principal Recipient (PR), which is basically the body that is legally responsible for distributing it or using it to tackle HIV, Malaria or TB in the country. The PR is often a government department or agency but it can be a local public or private organisation, and several different PRs may exist within one country.

How does the grant making process work?

Every nine to twelve months, the board will hold a funding 'round'. The round begins when the Global Fund invites all countries and organisations in need of funding to submit a grant proposal. It ends when all proposals have been processed and all eligible grants have been approved. So far there have been ten funding rounds.

To explain the funding process more fully, we are going to use the example of a fictitious country called Losimba.

The Governmental Health Authority in Losimba identifies a need for AIDS prevention and treatment work to be done. There are a number of organisations already tackling HIV and AIDS in the country, but they are severely under-funded. The Losimbian Health Authority works with these organisations through their Country Co-ordinating Mechanism (CCM) to prepare a proposal to the Global Fund for help.

The CCM submits the proposal to the Technical Review Panel (TRP), who thoroughly assess it. They find it to be satisfactory, and pass it on to the Global Fund's board with the recommendation that it be funded without condition.

The Global Fund approves a grant based on available funds, and appoints the Losimbian Health Authority as the Principal Recipient (PR) . The Secretariat then contract a Local Fund Agent (LFA) to oversee progress and ensure that the Health Authority have sufficient systems to administer funding properly.

The secretariat negotiates a two-year grant agreement with the Health Authority and both parties sign the grant. The secretariat then instructs the World Bank (as trustee) to make the first disbursement.

The Health Authority receives the first portion of the grant and, overseen by the LFA, distributes it to the agreed organisations in the country.

After a few months more money is needed, so the Health Authority apply to the secretariat for the next portion of their grant. As sufficient progress has been made and the LFA are in agreement, the next disbursement is made.

The initial two-year period comes to an end and the Global Fund's board make a full assessment of progress. They find that the Losimbian Health Authority has been using the money wisely and that the organisations receiving it are making good progress in combating AIDS. The grant is therefore renewed for a further three years, to the full five-year period.

For how long do grants last?

All grants are initially made on a two-year basis. If sufficient progress is made at the end of this two-year period, and it is confirmed that the money has been used wisely, the grant will be renewed and extended to the full period of 5 years. At the end of this period, a grant may be renewed for a further five years if it continues to produce good results.

How much money has the Global Fund distributed so far?

In its first eight years (2002-2010) the Global Fund has disbursed almost $11 billion for HIV/AIDS, malaria and tuberculosis out of a total approved sum of $19.3 billion.¹⁸

What structures are there in place to make sure that money goes to the people that need it?

One of the most important parts of the funding process is ensuring that the money given out in grants actually reaches the people who need it.

One of the most important parts of the funding process is ensuring that the money given out in grants actually reaches the people who need it. To ensure this happens, every Principal Recipient is assigned a Local Fund Agent (LFA). The LFA is an independent organisation contracted by the Secretariat to administer and verify the correct distribution of funds, and provide an ongoing analysis of financial and overall progress. There are currently a very wide range of different LFAs in operation worldwide (both public and private) including PricewaterhouseCoopers, Chemonics International, the United Nations Office for Project Services (UNOPS) and Crown Agents.

back to top Problems with the grant process

How quickly do Global Fund grants reach the people that need them?

One major area of concern is the amount of time that elapses between a grant being signed and the money arriving where it is needed.

Part of the problem is the rigorous checking that takes place to ensure that money will be going where it is supposed to and that proper systems are in place for its distribution. In some instances, this can cause problems in countries that don't have the administrative capacity to cope with the large amounts of monitoring and paperwork involved. It is also a problem in countries that already have highly bureaucratic governmental processes in place. In June 2004 for example, India was allocated $ 140 million for HIV and AIDS treatment, yet for over a year the grant remained unsigned and no money was disbursed. During this time, around 80,000 people are believed to have died from AIDS in India.¹⁹ The problems have since been resolved, but for this to happen, funding had to be cut, and a new management team brought in to administer the money.

Unfortunately the problems encountered in India are not unique, and a number of other countries, including Kenya and Uganda, have struggled to quickly and efficiently distribute the large sums they have received from the Global Fund.

Is there nothing the Global Fund can do to help with the distribution process?

The Global Fund is not designed as an implementing organisation, and as such, it cannot intervene directly to facilitate the distribution of funds. However, in August 2005, the GFATM did announce the launch of a new Early Alert and Response System (EARS)²⁰ to help overcome some of the problems with slow implementation. EARS is designed to be a support mechanism that will alert everyone involved in a particular grant project to any potential hold-ups. Action can then be taken by the government of the country concerned, or another 'facilitator'. In the case of India (mentioned above) this facilitator was the Clinton Foundation.

What other reasons are there for slow distribution of the money?

Many of the countries that receive Global Fund grants, are also countries that are covered by the World Bank and International Monetary Fund's Heavily Indebted Poor Countries (HIPC) scheme. HIPC was set up in 1996 as a way of helping countries out of the crippling external debt they acquired by accepting extensive loans from the World Bank and IMF in the 1970s, 80s and 90s. The scheme works on a conditional basis - in order to receive debt relief, a country has to agree to meet certain economic and financial criteria as outlined by a personalised 'Poverty Reduction Strategy Paper' (PRSP). The problem lies in the fact that this PRSP contains 'targets' for spending on public services that can effectively become 'limits' if more money than is budgeted comes into a country.

One such example is Uganda. When the country received several large grants from the Global Fund a few years ago, it sparked arguments between the health and finance ministries, who not wishing to go against IMF guidelines, refused to increase the country's healthcare budget to take into account the value of the grants. Had the Ugandan Health Ministry agreed to accept the full value of the grants at the rate intended, it would have effectively pushed a massive amount of money out of the department's existing budget for healthcare. Although this does not sound like a problem in principal, the money given by the Fund was specifically intended for AIDS, TB and Malaria, meaning all other areas of healthcare would have suffered extensive budgetary cuts.²¹

The World Bank and IMF have officially denied the active limitation of healthcare budgets in Uganda and elsewhere. However, many governments still impose restrictions because they believe it is the only way to maintain a good relationship with their debtors. The reasoning behind this strategy is that rapid exchanges of foreign cash can quickly increase the value of a nation's currency and therefore the price of its exports. This, say many finance ministers, could adversely affect competitiveness and displease the IMF. But, as the 2004 UNAIDS report on the Global AIDS epidemic states, "The short-term inflationary effects of increased and additional resources applied in tackling the HIV epidemic pale in comparison with what will be the long-term effects of half-hearted responses on the economies of hard-hit countries."²²

back to top Why have grants been cancelled or postponed?

The Global Fund has suspended and ended grants in several countries since it first began distributing funds, some of the most notable of which are Uganda, Myanmar (Burma), Ukraine, Kenya and Zimbabwe.

In Uganda, grants were stopped in August 2005 after the country's Local Fund Agent discovered financial irregularities within the Ministry of Health's special Programme Management Unit (PMU). It is believed that around $280,000 was misspent by individuals within the PMU over a period of several months. The Ugandan government quickly disbanded the PMU and brought in the international accounting and auditing firm Ernst & Young to temporarily oversee grant administration. Grant disbursement was restarted once Uganda had launched an enquiry into the case, but the failure to come up with a satisfactory long-term plan for Global Fund grant distributions meant the country failed to have two Round Two grants for TB and Malaria renewed beyond the initial two-year phase.²³ It also failed to receive new grants for HIV/AIDS and Malaria during the Round Six grant approval process, although a grant for TB was allocated.²⁴

In Myanmar, the Global Fund announced they would be cancelling all grants and withdrawing entirely in 2005, due to increasingly strict travel restrictions imposed on foreign workers by the governing military junta. The Fund had agreed to spend $100 million over five years in the country, which has an HIV+ population of around 360,000 and is thought to have one of the highest rates of tuberculosis in the world.²⁵ A "Three Diseases" (3D) fund has since been set up by the European Commission, Britain's DfID, Australia's AusAID, Sweden's Sida, the Netherlands and Norway to fund work on AIDS, Tuberculosis and Malaria in the country.²⁶ The Fund appears to be a success with $21 million in grants provided in 2007 to 23 implementing partners made up of UN agencies and international NGOs. These grants were renewed for a second year in 2008.

In Ukraine, a grant for HIV and AIDS was suspended in January 2004 following serious reservations about the way the programme was being governed. Subsequently, the International HIV/AIDS Alliance, a global NGO, became the sole recipient of the grant, and funding was restarted a month later.²⁷

In 2008 the Global Fund's Technical Review Panel (TRP) recommended that Kenya's application in Round 8 for $ 300 million be rejected. The reasons for this are unclear and the Kenyan government did not make public the reasons but national media reported mismanagement and misappropriation are the most likely causes. The Minister of Health has called for the suspension of Round 9 until management problems are resolved.

Also in 2008, Zimbabwe was accused by the Global Fund of misusing $7.3 million of a $12.3 million grant, and the Global Fund demanded the money be returned. Despite this the TRP did recommend Zimbabwe receive grant money in Round 8.

In September 2009, the Global Fund was forced to suspend funding to the Executive Secretariat of Mauritania's National AIDS Committee after it was found that funds had been used in a fraudulent and unjustified manner. The Fund has demanded the reimbursement of $ 1.7 million within 3 months and the immediate removal of the people identified as responsible of misusing the money. The Global Fund will still ensure that live saving ARVs are still accessable to people living with HIV but it will distribute these drugs through other means.²⁸

Other countries that have failed to have grants renewed for phase two funding include Nigeria, Senegal, South Africa and Pakistan.²⁹ Representatives from the Global Fund have described the cancellation and suspensions of grants as deeply regrettable, but have insisted that such action is always necessary to uphold the Global Fund's reputation as a transparent and fairly managed organisation that works with, rather than against the countries it supports.

In Russia, harm reduction programmes were put at risk when a programme funded by the Global Fund came to an end in August 2009. New funding was not approved as under the Global Fund's income eligibility policies Russia no longer eligible for HIV and AIDS funding. However, while the Russian Government took over funding or other prevention methods such as PMTCT and general population prevention, this did not include injecting drug users. UNAIDS urged Russia to reconsider its policy with Michel Sidibe saying that: "UNAIDS is very concerned that Eastern Europe and Central Asia is the only region of the world where HIV prevalence clearly remains on the rise,”³⁰ However, Russia did not take over and the prevention programme for injecting drug users was in political limbo from August -November 2009 until the Global Fund reversed their previous decision and granted $24 million.³¹ The Global Fund took this decision "on an extraordinary basis, to extend the grant to the Open Health Institute in recognition of the emergency situation that would have arisen if funding had been discontinued." The grant is due for to be reviewed in January 2012.

In late 2010, it was revealed that the Officer of the Inspector General at the Global Fund had uncovered cases of defrauding of Fund grants in four countries (Zambia, Cameroon, Mali and Mauritania), amounting to at least $25 million in 'missing funds'.³² The findings caused Sweden, and later Germany,³³ to suspend their annual pledges to the Fund. In January 2011, these cases of misappropriation were widely publicised by the Associated Press³⁴ prompting the Global Fund to release statements regarding its 'zero tolerance' to corruption, and clarifying the steps it was taking to recover the funds and prevent future misuse of grant money.^{35 36}

It was announced in November 2011, that due to funding restrictions Round 11 would be replaced by a Transitional Funding Mechanism. The Global Fund has put this emergency funding mechanism in place to ensure the continuation of essential services to existing recipient countries.^{37 38}

back to top Global Fund vs. PEPFAR

How does the Global Fund compare overall to other funding initiatives such as PEPFAR?

Much has been made of the apparent rivalry between the UN backed Global Fund and the US fronted PEPFAR, and there have been many arguments about which scheme has been more successful at tackling global health problems. Some say PEPFAR is better because it is more specific in its targets, distributes more money and gets faster results. However as well the debatable wisdom of allocating money on a 'moral' basis, there remain questions over how thoroughly the whole process is being checked to ensure the money actually reaches those in need. Others champion the Global Fund, insisting its independence, wide remit, systematic vetting process and insistence on organisational 'transparency' guarantees every penny reaches people in need. As we have seen, all this can be at the cost of speedy distribution of funds however, and levels of donor investment in the Fund remain critically low.

The reality is that PEPFAR and The Global Fund are both important in the global fight against disease. Trying to imply that one is intrinsically 'better' than the other is perhaps misguided, because ultimately, a life saved is a life saved no matter which scheme supplies the means to do it.

back to top What about the future of the Global Fund?

What progress has been made?

...through AIDS programs supported by the Global Fund 2.78 million people living with HIV have been reached with lifesaving treatment.

Despite the problems, Global Fund money has produced many practical and positive results. In regards to HIV and AIDS, 4.9 million orphans have been provided with basic care and support, 2.3 billion condoms have been distributed, and 930 thousand HIV-positive pregnant women have received antiretroviral treatment to reduce mother-to-child transmission. Through AIDS programmes supported by the Global Fund 2.8 million people living with HIV have been reached with lifesaving antiretroviral treatment.³⁹

Such progress is very good news for both recipients and donors, although contributions from all sectors will need to increase if the Fund is to keep up with demand.

What does the future hold for the Global Fund?

As the Global Fund matures, there are three key issues that it will need to address. Firstly, there is the issue of implementation. As already discussed, the Global Fund is not designed to be an implementing agency, and is unlikely to change this remit. Despite the introduction of EARS, slow disbursement of funds is an ongoing problem in countries that don't have the staff, health system capacity or bureaucratic structures to absorb and distribute large grants. The delays may be exacerbated by problems with the Global Fund monitoring and reporting requirements, which some countries have reported to be complicated and inconsistent.⁴⁰

... perhaps the most vital issue is how to maintain and increase donations to the Global Fund.

Secondly, there is an ongoing debate about whether the Global Fund should only be giving money to AIDS, Tuberculosis and Malaria, when many countries are in need of much wider funding for health, and in particular, for strengthening their basic health systems. There have even been calls for medical staff salaries to be paid directly by the Fund.⁴¹ In the fourth round of funding, grants for general health system strengthening were permitted, though this practice was cancelled in round 5 after protests that such grants exceeded the Global Fund's remit. Many are now calling for general health system strengthening grants to be reinstated to allow countries to expand health services for all, and not just those with HIV, TB or Malaria.⁴²

Finally, perhaps the most vital issue is how to maintain and increase donations to the Global Fund. The September 2007 replenishment meeting saw a notable drop in donor pledges from some governments⁴³ , while others (such as the UK pledge) were substantially less than many campaigners had hoped for.⁴⁴ In October 2010, donor governments pledged $11.7 billion over three years at the replenishment meeting, which was less than the $13 billion 'lowest funding level' identified by the Global Fund as necessary to continue to expand its work and far less than the 'ideal' $20 billion objective. As a result, expanding access to prevention, care and treatment programmes will be more difficult, and efficiency savings (such as providing money only to those countries that are seen as 'the worst affected') may have to be considered.⁴⁵

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Sources back to top

• IDA ARV Procurement Services: www.ida-arv.nl
• New York Times Editorial (19 May 2005) "Preserving the Global AIDS Fund" - 2005
• Medecins Sans Frontieres: www.msf.org
• Oxfam (2002) 'False Hope or New Start: The Global Fund to Fight HIV/AIDS, TB, and Malaria', Oxfam Briefing paper no. 24. - 2002
• Aidspan: www.aidspan.org
• The Global Fund Website: www.theglobalfund.org
• SHAKOW, Alexander (19 January 2006) "Global Fund - World Bank HIV/AIDS Programs: Comparative Advantage Study" Global Fund Website - 2006

References back to top

1. [PDF] The Global Fund 'The Framework Document of the Global Fund to Fight AIDS, TB, and Malaria'
2. G8 Communication (July 2000) G8 Communique Okinawa
3. UN Press Release (April 2001) Secretary-General Proposes Global Fund for fight against HIV/AIDS and other infectious diseases at African Leaders Summit
4. AIDSpan (Jan. 2009) A Beginners Guide to the Global Fund
5. Global Fund Press Release (July 2009) Global Fund Board Appoints Minister of Health of Ethiopia as Chair
6. Global Fund Press Release (December 2009) President Obama signs $1.05 billion contribution to the Global Fund for 2010
7. United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 U.S. Congress Public Law 108-25
8. (PRODUCT)RED website (accessed 17 January 2007)
9. THE LANCET: RED (5-11 August 2006) The Lancet, Vol. 368 No. 9534
10. Global Fund Website: PRODUCT (RED)
11. AFP (15 February 2008) "Bono-sponsored art auction raises 42.5 million dollars for AIDS"
12. FRAZIER, Mya (05 March 2007) 'Costly Red Campaign Reaps Meager $18 Million', AdAge.com
13. BUY (LESS) website
14. Global AIDS Alliance (2007) "Debt2Health Initiative"
15. Global Fund Press Release (25 September 2007) "Debt conversion initiative launched to fund health programs"
16. Global Fund website (February 2009) Distribution of Funding for Round 7
17. Global Fund website (February 2009) Distribution of Funding for Round 7
18. The Global Fund (April 2010) Global Fund Grants - Summary Report
19. STERN, R. (May 2005) "Millions in Global Fund grants go unused: Indian government bureaucracies kill off people living with AIDS." HIV-treatment bulletin, Vol. 6 No.5, p.14
20. Global Fund Website (12 August 2005) EARS - Early Alert and Response System letter
21. Ooms, G & Schrecker, T. (21-27 May 2005) "Expenditure ceilings, multilateral financial institutions, and the health of poor populations", The Lancet, Vol. 365 No. 9473
22. UNAIDS (2004) Report on the Global AIDS Epidemic 2004, p.146.
23. Global Fund Observer (10 March 2007) "Global Fund Terminates Two Grants to Uganda" Issue 73.
24. New Vision, Kampala (6 November 2006) "Global Fund cuts Uganda's HIV/AIDS funding"
25. UNAIDS website (accessed 25 January 2007) Myanmar Country Profile
26. Xinhua News Agency (16 June 2006) "Myanmar launches 3D Fund to substitute GFATM"
27. Global Fund Press Release (24 February 2004) Global fund signs letter of intent to relaunch Ukraine HIV/AIDS grant
28. Global Fund Press Release (9th September 2009) "Global Fund suspends grant to the Executive Secretariat of the National AIDS Committee in Mauritania"
29. Global Fund Observer (10 March 2007) "Global Fund Terminates Two Grants to Uganda" Issue 73.
30. UNAIDS Press Release (27th October 2009) "Eastern Europe and Central Asia HIV Conference for Join efforts towards Universal Access"
31. Global Fund Press Release (13th November 2009) "Global Fund to provide $24 Million of new funding to fight HIV/AIDS in Russia"
32. The Lancet (2010, November 13th) 'Defrauding of the Global Fund gives Sweden cold feet' 376(9753): 1631
33. ABC News (2011, January 26th) 'Germany suspends payments to global health fund'
34. Associated Press (2011, January 23rd) 'AP Enterprise: Fraud plagues global health fund'
35. The Global Fund (2011, January 24th) 'Global Fund statement on abuse of funds in some countries'
36. BBC News (2011, February 4th) 'Global Fund Against Aids cracks down on fraud'
37. Global Fund (2011, November) 'Important Update: Establishment of Transitional Funding Mechanism to replace Round 11'
38. The Global Fund (2011, 23rd November) 'The Global Fund adopts new strategy to save 10 million lives by 2016'
39. Global Fund Press Release (2010, 8th June) '2.8 million people on AIDS treatment through Global Fund investments'
40. Oomman, Nandini; BERNSTEIN, Michael; ROSENZWEIG, Steven (10 October 2007) "Following the Funding for HIV/AIDS: A comparative analysis of the funding practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia" HIV/AIDS Monitor & The Center for Global Development
41. OOMS, Gorik; VAN DAMME, Wim; TEMMERMAN, Marleen (April 2007) "Medicines without Doctors: Why the Global Fund Must Fund Salaries of Health Workers to Expand AIDS Treatment" PLOS Medicine, Vol. 4 Issue 4.
42. The Lancet Infectious Disease (November 2007) "The Global Fund: growing pains" Vol. 7 Issue 11.
43. The Lancet Infectious Disease (November 2007) "The Global Fund: growing pains" Vol. 7 Issue 11.
44. BOSELEY, Sarah (26 September 2007) "Campaigners attack UK over Aids funding" The Guardian
45. Financial Times (2010, October 5th)'Global disease fund fails to hit target'