FAQ
A Partnership to Prevent and Treat AIDS, Tuberculosis and Malaria
AIDS, tuberculosis and malaria are preventable diseases that can be treated effectively. Yet, they were the cause of more than six million deaths in 2004. Relative to high-income countries, the burden of these diseases is thirty times greater in developing countries, resulting in tremendous economic loss, social disintegration and political instability. The Global Fund to Fight AIDS, Tuberculosis and Malaria was created in 2002 to respond to this formidable challenge.
- What is the Global Fund?
- How does the Global Fund work?
- What is the Global Fund's track record?
- What difference will the Global Fund make in people's lives?
- How is the Global Fund accountable?
- Who are the Global Fund's partners?
- What are the Global Fund's current resource needs?
What is the Global Fund?
The Global Fund’s purpose is to attract and disburse additional resources to prevent and treat AIDS, tuberculosis (TB) and malaria. As a partnership between governments, civil society, the private sector and affected communities, the Global Fund represents a new approach to international health financing. The Fund works in close collaboration with other bilateral and multilateral organizations, supporting their work through substantially increased funding.
The Global Fund relies on local ownership and planning to ensure that new resources are directed to programs on the frontlines of this global effort. Its performance-based approach to grant-making – where grant awards are disbursed incrementally, based on measures of progress – is designed to ensure that funds are used efficiently to scale up proven interventions.
The Global Fund is an independent organization, governed by an international Board that consists of representatives of donor and recipient governments, non-governmental organizations (NGOs), the private sector (including businesses and philanthropic foundations) and affected communities. Also participating in ex-officio capacity are representatives of the World Health Organization (WHO), UNAIDS, and the World Bank. The latter also serves as the Global Fund’s trustee. The Chair of the Global Fund’s Board is Dr. Carol Jacobs, Chair of the National Commission for HIV/AIDS of Barbados, taking over the role of Chair from United States Secretary of Health and Human Services Tommy G. Thompson. The Vice-Chair is Prof. Michel Kazatchkine, M.D., France's Ambassador on HIV/AIDS and Transmissible Diseases, taking over the role from Dr. Hélène Rossert-Blavier, Director-General of the French non-governmental organization AIDES. Both were elected at the Global Fund’s 10th Board meeting in April 2005.
The Global Fund’s by-laws also call for the formation of a broad group of stakeholders referred to as the Partnership Forum. The Global Fund’s First Biennial Partnership Forum convened in July 2004 in Bangkok to review progress and provide counsel to the Fund in the form of recommendations to the Board. The Board and its committees responded to these recommendations with action at the Ninth Board Meeting in Arusha, Tanzania in November 2004 in the form of policy changes or further study of the issues.
The Global Fund’s Secretariat is based in Geneva, Switzerland. The Secretariat aspires to be as lean an operation as possible with a ceiling of 150 staff, of which approximately 135 positions were filled as of April 2005. In 2004, 1.5 percent of total expenditure was used for central administration and management of the Global Fund. An additional 0.8% was used for local oversight of grants by Local Fund Agents (see box for description of LFAs). Dr Richard Feachem joined as Executive Director in July 2002.
Key Global Fund structures:
- Country Coordinating Mechanisms (CCMs): Country-level partnerships that develop and submit grant proposals to the Global Fund, monitor their implementation and coordinate with other donors and domestic programs. CCMs are intended to be multi-sectoral, involving broad representation from government agencies, NGOs, community- and faith-based organizations, private sector institutions, individuals living with HIV, TB or malaria, and bilateral and multilateral agencies.
- Technical Review Panel (TRP): An independent panel of disease-specific and cross-cutting health and development experts that provides a rigorous review of the technical merit of applications. The TRP may recommend to the Board that proposals be funded without condition, approved conditionally, resubmitted or not approved. Thus far, the TRP has recommended funding for 38% of the proposal requests submitted through four rounds of funding.
- Principal Recipient (PR): A local entity nominated by the CCM and confirmed by the Global Fund to be legally responsible for grant proceeds and implementation in a recipient country. Periodic disbursement of funds to the PR is based on the achievement of measurable results. There may be multiple public and/or private PRs in a country.
- Local Fund Agent (LFA): Independent organizations contracted by the Secretariat to assess a PR’s capacity to administer funds and provide ongoing oversight and verification of grantee-reported data on financial and programmatic progress. A global competitive tender was conducted to identify a list of nine pre-qualified LFAs for the countries in which the Global Fund operates. This was followed by a competitive tender issued at the country level for all pre-qualified contractors. Through a global competitive tender process, ten organizations have been pre-qualified to provide LFA services in the countries in which the Global Fund operates. Of these, the following are currently providing in-country services: Centre for International Health, Swiss Tropical Institute (Switzerland); Crown Agents (UK); Deloitte Touche Tohmatsu Emerging Markets LTD (USA); KPMG LLP (USA); PricewaterhouseCoopers (Switzerland); and United Nations Office for Project Services.
How does the Global Fund work?
The following process used by the Global Fund to approve and administer grant awards is designed to maximize the participation of local stakeholders, ensure accountability and provide transparency with respect to both decision-making and operations:
- The governments of developing countries work with civil society organizations and partners through CCMs to prepare proposals that fill financing gaps in local HIV, TB and/or malaria programs.
- Eligible proposals submitted to the Fund are reviewed for technical merit by the TRP; recommended proposals are considered by the Global Fund Board and approved based on available funds.
- The Global Fund Secretariat appoints an LFA in countries with approved grants. The LFA assesses the capacity and systems of the PR that has been nominated by the CCM.
- The Secretariat negotiates a two-year grant agreement with the PR, after which the PR receives its first disbursement. The PR in turn makes disbursements to local implementing organizations.
- The PR periodically requests additional disbursements from the Secretariat, based on evidence of progress achieved, verified by the LFA.
- Based on verified disbursement requests, the Secretariat instructs the World Bank (as trustee) to make disbursements throughout the two-year period. The flow of funds is linked to continued progress.
- Overall two-year program performance is evaluated by the Global Fund to determine whether to renew grants through to their full term (typically 5 years in total), depending on availability of funds.
- If the grant is approved for continued funding, the Secretariat negotiates a grant agreement to cover the remaining years of the grant lifespan.
What is the Global Fund's track record?
In four rounds of funding, the Global Fund has approved grants worth US$ 3.4 billion through more than 300 grants to 127 countries, including those with the greatest present disease burden and those at risk of future disaster. Approximately sixty percent of this total is for Africa; nearly 60% is for AIDS. Half of the money will be used by governments; half by non-governmental partners. Nearly half is for the purchase of medicines and commodities, and half is for infrastructure, training and other support costs. In its first year, the Secretariat designed and implemented a performance-based system of grant-making to help ensure the most effective use of donor funds. With this infrastructure now in place, the process of negotiating and signing grant agreements is well underway and the rate of signed agreements and disbursements is increasing dramatically. By June 3, 2005, the Global Fund had signed agreements for 89 percent of approved grants and disbursed US$ 1.2 billion to public and private recipients in 124 countries. The Global Fund’s Board will approve a fifth round of funding in September 2005 (deadline for applications: 10 June 2005).
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What difference will the Global Fund make in people's lives?
With Global Fund resources, approved local programs will support an unprecedented scale-up of HIV treatment. Over five years, an estimated 1.6 million people will receive antiretroviral treatment, a six-fold increase over current coverage in developing countries. With 100 percent of AIDS grants featuring prevention programs, countries implementing voluntary counseling and testing (VCT) services will also expand their reach to over 52 million people. An expected one million children orphaned by AIDS will receive support through medical services, education and community care, and 3.5 million people with infectious TB will be treated successfully using DOTS, the internationally approved TB treatment strategy. Over this same period, the Global Fund will help to quadruple the coverage of treatment of multi-drug resistant TB, and finance 145 million artemisinin-based combination drug treatments for resistant malaria and 108 million insecticide-treated bed nets to prevent malaria.
Examples of approved programs include: the creation of six centers of excellence for the treatment and support of women living with HIV, their newborns and families in Democratic Republic of Congo; extending preventive education, and diagnosis and treatment of TB to 56 million people in three newly created states in India, with programs tailored for the urban poor, remote rural communities and indigenous peoples; funding Zambia’s switch to a new first-line treatment for drug-resistant malaria; and an HIV/AIDS prevention and treatment effort in Ukraine, targeted particularly at vulnerable populations to reduce the rapidly growing HIV prevalence in the country and improve care and support for those living with HIV.
The Tsunami and the Global Fund’s Response Four of the countries devastated by the tsunami – India, Indonesia, Sri Lanka and Thailand – have approved grants worth a combined total of US$ 269 million to date to support programs to fight AIDS, TB and malaria. Global Fund staff traveled promptly to affected countries to assess the impact on existing programs and the potential for shifting resources. Some funded programs were severely affected by the loss of staff that were killed in the disaster and the physical destruction of health infrastructure. For example, Banda Aceh, the worst-affected part of Indonesia, lost thousands of health workers. In addition, the increased potential for malaria epidemics and the interruption of TB or ARV treatment in the affected areas resulted in the need for some shifting of staff and financial resources from other parts of the country. In Sri Lanka, where nine out of twelve districts implementing Global Fund-financed programs were severely affected, four grants that were approaching the end of their initial two-year funding phase were given an extension to apply for continued funding. |
Sample results to date include:
- Zanzibar – 500 clinicians from the public and private sectors trained in new malaria treatment policies and more than 178,000 children treated for malaria;
- Haiti – over 2,300 people living with HIV/AIDS receiving antiretroviral treatment through a pioneering approach using community members to promote treatment adherence;
- China – nearly 270,000 people diagnosed and treated for TB contributing to an increase in the TB case detection rate from 20 percent in 2001 to nearly 50 percent in 2004.
How is the Global Fund accountable?
The Board and Secretariat have incorporated a number of accountability mechanisms into the Global Fund’s grant review, awards and disbursement processes. The first level of responsibility lies with local CCMs, which should include in their proposals to the Global Fund plans for independent audits of program financial statements. In addition, prior to the signing of an agreement, the LFA certifies the fiscal and administrative capacity of the PR. Through a grant agreement with the Global Fund, PRs are accountable for the use of grant funds and program results. Throughout the grant period, periodic disbursements of funds are linked to progress identified in programmatic and financial updates submitted by the PR. The LFA provides an independent verification of these updates. As the coordinating body at the country level, the CCM oversees and monitors progress during implementation.
The Global Fund has adopted other decisions to ensure fiscal prudence and the efficient use of funds. For example, grant awards are made only on the basis of confirmed donor pledges, and signed agreements must be based on funds actually received from donors. The Fund has also adopted an innovative drug procurement policy, which ensures that recipients can secure the lowest available price for quality pharmaceuticals.
Finally, one of the Global Fund’s key operating principles is transparency. This is perhaps best illustrated by the broad content of its website. Approved proposals, signed grant agreements and recipient disbursement requests (which also contain program progress updates) are available for review, as are CCM analyses, documents discussed at Board meetings and information about the Fund’s structure and governance.
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Who are the Global Fund's partners?
The Global Fund represents one important part of a comprehensive global response to AIDS, TB and malaria. Multilateral development partners and bilateral agencies provide complementary support to countries, including: technical assistance for monitoring and evaluation; support for capacity building, including human resources as well as product procurement and supply chain management; dissemination of best practices; and financial assistance. Local planning by CCMs is designed to coordinate new activities with those that already exist to ensure that Global Fund efforts are additive. As a financing mechanism, the Global Fund works closely with key international allies, such as UNAIDS, the World Health Organization (WHO) and the World Bank, and major partnerships, including Stop TB and Roll Back Malaria.
NGO and private sector participation are key to the Fund’s operations – on the Board and TRP and in CCMs and the Secretariat. NGOs offer constructive scrutiny of the Fund’s activities and ensure engagement with civil society. Private sector partners and foundations provide both direct funding and in-kind assistance. In addition, the Global Fund is working with businesses to encourage the expansion of workplace prevention and treatment programs into communities in recipient countries.
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What are the Global Fund's current resource needs?
To establish and sustain the Global Fund, international donors – including 45 countries, as well as major foundations and private donors – have pledged significant new resources. Between 2001 and 2004, pledges totaled US$ 3.4 billion, with an additional US$ 2.7 billion pledged to date for 2005 to 2008. While significant, pledges for 2005 – currently totaling US$ 1.4 billion – are not enough to finance a new funding round in addition to the grant renewals due in 2005, falling short of projected needs by approximately US$ 0.9 billion. However, further pledges are anticipated in the course of the year. In addition, the Global Fund has initiated a Voluntary Replenishment process to help ensure more stable, predictable funding for 2006-2007. Over the course of three replenishment meetings in 2005, it is hoped that donor countries will move towards a replenishment cycle of financing the Global Fund, with larger and longer term commitments.
The renewal of effective programs will be critical to sustain momentum in the fight against HIV/AIDS, tuberculosis and malaria and to ensure the consistent provision of life-saving medicines to people on treatment. Round 4 was confirmed in June 2004, and the first renewals of Round 1 grants began in early 2005. The Fifth Call for Proposals was made in March 2005 with a deadline for funding proposals of 10 June 2005. Round 5 proposals will be approved at the 11th Board meeting in September 2005, following the Third Voluntary Replenishment Conference.
The magnitude of the Global Fund’s resource needs means that the majority of funds must be raised from the public sector, including funding from new donors and additional contributions from developed countries that have pledged previously. However, businesses and private foundations also have important roles to play in the Global Fund, both as donors and partners. In addition, local financing and leadership among developing countries must increase as new global financing grows. As a global responsibility, the Global Fund requires unprecedented commitments from all stakeholders.
Figures are subject to change and may include anticipated information. For more information about the Global Fund, please visit www.theglobalfund.org.
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