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What is the Global Fund?The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is an independent public-private partnership that was first proposed by the UN Secretary-General, Kofi Annan, back in 2001, and officially came into being in 2002. Its aim is to raise funds and pool money from governments, businesses and individuals around the world, and channel it into programmes to fight AIDS, TB and Malaria. Who contributes to the Fund?Around fifty countries have pledged money to the GFATM so far. 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. The board of the Global Fund does not dictate how much money should be donated per se, but guidelines are issued to demonstrate how much will be needed to maintain funding and approve new grants. Donor countries are expected to meet a proportion of this estimate dependent on their GDP, though pledges are essentially made on a 'goodwill' basis (although obviously there is a certain political kudos attached to being a donor). This allows the funding level estimates to be increased in the event of an emergency. More recently, The Fund has also introduced a new system based on regular periodic replenishments to replace the previous 'ad hoc' method of donation. It is hoped that this system will attract more future donors and enable more accurate forecasting of the resources available over the coming years. As well as national governments, contributions 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) and from fund raising events. A Real Madrid Soccer Match held in 2002 for example raised a grand total of $112,487 in one game alone. Essentially anyone can donate to the Fund however and more information about how to do this can be found on the GFATM's donations page. Which countries receive money from the Fund?In total, 127 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. At present about 61% of the money goes to African nations, 23% goes to Asia, the Middle East and North Africa, and 16% goes to Latin America, the Caribbean and Europe. 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 President Bush's 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 (incidentally around 56% of funding is currently being spent on HIV and AIDS, 31% is being used to fight Malaria and 13% is going on TB programmes) allowing greater flexibility in tackling the most urgent crises. 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 many different PRs may exist within one country . How is the Global Fund run?The Fund is governed by an international board consisting of nineteen voting members and four non-voting members. Voting members include government representatives from donor and recipient countries as well as representatives from affected communities, private sector businesses, philanthropic foundations and NGOs. Representatives of UNAIDS and the World Health Organisation (WHO) also participate as ex-officio (non-voting) members, as do the World Bank, who serve as the Global Fund's trustee. A large group of stakeholders known as the Partnership Forum also meet twice a year to review progress and provide advice and suggestions to the Fund's board. All global Fund activities must conform to a comprehensive set of By-Laws that set out the Fund's mission and rules. As a Swiss non-profit foundation, they must also conform to appropriate Swiss law. The current chairperson of the Fund's Board is the US Secretary of Health and Human Services, Tommy Thompson, who took over from Dr Chrispus Kiyonga of Uganda in January 2003. The vice-chair is Dr Hélène Rossert-Blavier, the General Director of the French NGO AIDES . The day-to-day running of the Fund is carried out by a Secretariat of 70 people based in Geneva, Switzerland. This secretariat is overseen by the Fund's Executive Director, Dr Richard Feachem. A special group called the Technical Review Panel (TRP) also exists to review grant applications made by recipient countries. The TRP is made up of an independent panel of health development 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, that it is approved with conditions, that it is rewritten and resubmitted or that it is rejected altogether. 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. 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) that include PricewaterhouseCoopers, Chemonics International, the United Nations Office for Project Services (UNOPS) and Crown Agents. 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 validity period of 5 years. How does the grant making process work?Every nine months or so (or longer if the funds available to the Global Fund are insufficient), the board will hold a funding 'round'. The round begins when the 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 four funding rounds, with a fifth confirmed to start in March 2005. 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 (LHA) 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 LHA as the Principal Recipient (PR) . The Secretariat then contract a Local Fund Agent (LFA) to oversee progress and ensure that the LHA have sufficient systems to administer funding properly. The secretariat negotiates a two-year grant agreement with the LHA and both parties sign the grant. The secretariat then instructs the World Bank (as trustee) to make the first disbursement. The LHA 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 LHA 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 LHA 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. How much money has been pledged so far?A grand total of $6,018,588,232 has been pledged to date (7th March 2005) of which $3,333,880,572 has actually been paid into the Fund's central bank account. Pledges vary in duration, with some being valid for just one year and others valid for five or six years until 2007 or 2008. This is why not all pledges have been paid in full yet. For the most part, countries and organisations that have made pledges have delivered on their promise, although there was a recent problem with Italy, who withdrew a pledge due to economic difficulties before bowing to public pressure and reinstating it a few months later. How much money has the Fund distributed so far?The table below shows the grants that have been approved by the Global Fund so far, and the money that has actually been distributed (accurate as of 7th March 2005)
* These amounts are based on a scenario whereby all grants are renewed for the full 5-year period. This may not necessarily happen in practice. The amount of money promised to recipient countries seems to be less than the Fund has actually received in pledges. Is this a problem?It could be, yes. The GFATM is currently facing a funding gap of just over $2 billion. While the $5.9 billion that has been pledged so far is enough to fund the first two years all grants, it is over $2 billion short of the $8.1 billion that will be needed to fund all grants for their full 5-year period. And unfortunately, this $8.1 billion is just the amount of money that is needed to maintain current projects. The Fund will soon be holding a fifth round of funding where it will invite more countries and organisations to apply for grants. Unless substantial amounts are pledged by wealthy nations and foundations soon therefore, this new round of funding will not be able to go ahead, and many promises already made may have to be broken. The consequences of this for the people who rely on Global Fund money could be catastrophic. Why do wealthy countries such as the USA not donate more money if there's such a funding gap?Unfortunately many countries have their own agenda when it comes to funding relief programmes. In the US for example, PEPFAR (the President's Emergency Plan For AIDS Relief) is generally considered the preferred recipient for overseas HIV prevention and treatment funding. While the US has given a significant amount to the Global Fund, Congress has dictated that this amount is capped at either $1000 m per year, or 33% of the overall total of pledges received (33% being the US percentage of global GDP). This means that if other countries give less, so does the US. The thinking behind this may have a lot to do with the US's own political agenda. One of the main rules about pledging to the GFATM is that this money comes '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. Given the US's strong opposition to Harm Reduction strategies and Needle Exchange programmes amongst injecting drug users for example, it is perhaps unsurprising that America prefers to channel money into a home-grown scheme that does not support such initiatives. The same may also be true of condom promotion and the use of generic drugs, both of which the Bush administration is known to be fundementally against . Some have suggested that this 'no strings attached' rule could be altered to encourage more nations (not just the US) to give money. While this could create more complex problems with the tracking of funds, some say that it would be better for Country A to give $100 m with the proviso that it didn't go to Country B, than for Country A to give no money at all. Are there any other problems?One area of concern is the drugs that Global Fund money is being used to buy. The Global Fund specifies in its regulations that only drugs that have been prequalified by the WHO can be used in treatment programmes. However the WHO prequalification project is under-supported and has been slow to approve many HIV drugs, particularly the cheap generic drugs that are so vital to treating large numbers of people. Last year, several drugs were even removed from the WHO's list following problems with research methods. Some have since been reinstated, but the process for reassessment is slow, meaning the number of drugs available to Global Fund treatment projects is currently limited. This is probably the reason why only around 265,000 people are currently on ARV drugs as a direct result of Global Fund money. Another problem is the amount of time that elapses between a grant being signed and the money getting where it is needed. Of the $562m worth of grants approved in the first round of funding back in early 2002 for example, only two thirds ($375m) has actually been distributed to the recipient nations. Much of the problem lies with the rigorous checking that takes place to ensure that the money will be going where it is supposed to and that proper systems are in place for its distribution. Unfortunately, while all this takes place, people are dying. The Global Fund says that as more CCMs and communication networks are set up, the grants will be distributed more rapidly. However, it is unclear at what sort of rate this is actually happening. What progress has been made?Despite the problems, Global Fund money has produced many practical and positive results. Many of these are listed on the Global Fund's website. General progress includes the training of healthcare professionals, the provision of insecticide treated mosquito nets, the supply of ARV drugs, the modernisation and conversion of labs and healthcare centres and the rapid expansion of the DOTS TB treatment strategy in dozens of different countries. What we don't know however is a) how much and b) what percentage of funding is being used for each type of initiative. 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 and gets faster results. However there remain questions over how thoroughly the process is being checked to ensure the money actually reaches those in need. Others champion the Global Fund, insisting its wide remit, systematic vetting process and insistence on organisational 'transparency' guarantees every penny reaches people in need. This can be at the cost of speedy distribution of funds however. The reality is that PEPFAR and The Global Fund are both equally essential in the global fight against disease. Trying to imply that one is intrinsically 'better' than the other is pointless, because ultimately, whether the money comes from PEPFAR or the Global Fund, it can be used to save lives. For more information about PEPFAR and the other schemes currently tackling HIV and AIDS around the world, please visit our World AIDS epidemic page. Author: Bonita de Boer Sources:
Last updated March 8, 2005 | ||||||||||||||||||||||||||||||||||||||||||||||||||