Global Fund to Fight AIDS, Tuberculosis, and Malaria (revised)

The concept of a new international effort to increase coordination and mobilize additional resources to fight HIV/AIDS, tuberculosis, and malaria was first proposed at the July 2000 G-8 Summit in Okinawa. On May 11, 2001, President Bush announced a U.S. pledge of $200 million to support such a global fund, the first contribution by any government. In June 2001, at the urging of United Nations Secretary-General Annan, Secretary Powell, and many other national leaders, the UN General Assembly Special Session on HIV/AIDS unanimously endorsed the concept of a Global Fund, and by the time of their meeting in Genoa a month later, G-8 leaders had pledged $1.3 billion in support. Pledges now total over $3.3 billion. The U.S. has pledged $1.65 billion^*, or 50% of the total. In January 2002, the Global Fund was formed as a charitable foundation, based in Geneva. The Board held its first meeting in January 2002, and in April 2002 approved its first round of grants. At its January 2003 meeting, the Board elected U.S. Health and Human Services Secretary Tommy G. Thompson as Chair and approved its second round of grants.

Purpose
The Fund is intended "to attract, manage, and disburse additional resources through a new public-private partnership that will make a sustainable and significant contribution to the reduction of infections, illness and death, thereby mitigating the impact caused by HIV/AIDS, tuberculosis, and malaria in countries in need, and contributing to poverty reduction as part of the development goals contained in the Millennium Declarations." The Fund is intended to complement bilateral and multilateral assistance programs already underway, without duplicating or replacing existing funds.

Resources
As of February 2003, governments, corporations, foundations, and individuals had pledged approximately $3.3 billion to the Global Fund. Many of the pledges are multi-year; over $800 million was made available for disbursement for approved grantees in calendar year 2002. The United States, the largest contributor to the Fund, has pledged $1.65 billion^* over 7 years. The U.S. made available $275 million of the funds during FY02.

Approved first-round grants total $616 million over 2 years to 58 projects in 40 countries, distributed as follows: Africa 52%, Americas 13%, Eastern Mediterranean 1%, Eastern Europe and Central Asia 8%, Southeast Asia 12%, and Western Pacific 14%. Roughly 60% of the awarded funds in round one to projects working on HIV/AIDS, 10% to fight malaria, and 16% on tuberculosis, and an additional 15% to programs fighting HIV/AIDS combined with one or both of the other diseases.

Approved second-round grants total $866 million over 2 years to 98 projects in 60 countries, distributed as follows: Africa 61%, Americas 9%, Eastern Mediterranean 8%, Eastern Europe and Central Asia 9%, Southeast Asia 9%, and Western Pacific 4%. Roughly 57% of the total are programmed to the fight against HIV/AIDS, 28% toward malaria, 14 % toward tuberculosis, 1% to integrated TB/HIV programs, and less than 1% toward fully integrated programs. For the most up-to-date information on signed grant agreements and disbursements please check the Global Fund website at www.globalfundatm.org.

While there is no doubt that more contributions will be needed to fund future proposals, it is important that the Fund not replace existing funding and programs at country level. As a financing mechanism, the Fund depends on the work being done by bilateral agencies such as the U.S. Agency for International Development and the U.S. Department of Health and Human Services, which provide invaluable technical and program assistance to help build the capacity needed to implement Global Fund programs. Bilateral and multilateral assistance programs will be vital to ensuring success for projects, including those supported by the Global Fund. If resources generated by the Global Fund are not treated as additional, but replace monies from another source, it will not have the expected impact on the three diseases.

Governance
The Global Fund is an independent legal entity, incorporated under Swiss Law as a charitable foundation. The Board of Directors acts as the ultimate decision making body. The 23-member Board is composed of both voting and non-voting members. The 18 voting members are composed of 14 countries representing both donor and recipient nations, a foundation representative, a representative of the for-profit private sector; and two non-governmental organization representatives., The Board also has five non-voting members: representatives from the World Health Organization, UNAIDS, the World Bank; a representative for people living with the diseases; and a Swiss citizen, as required by Swiss law. Governance procedures will evolve, and the goal is to have a flexible and innovative management structure. The Board is planning a "Partnership Forum" every 2 years to gather all stakeholders, including those not presently participating on the Board, to advise the Fund, provide additional input, and coordinate actions and efforts in the fight against the three diseases.

The Secretariat, headed by Executive Director, Dr. Richard Feachem, manages the Fund on a day-to-day basis. A Technical Review Panel (TRP) reviews all proposals to ensure that they are scientifically, technically, and developmentally sound, and has recommended about 40% of applications received in the first two rounds to the Board for funding. The TRP is an independent group of 22 international experts in the three diseases, and in the fields of prevention, clinical care, health education, and health economics.

Grants
Inclusive, broad-based partnerships in each country, referred to as Country Coordination Mechanisms (CCM), which brings together national and local governments, non-governmental organizations (NGOs), and the private sector, submit proposals to the Fund. In countries where a CCM either does not exist or does not function adequately because of unusual circumstances (such as conflict, natural disaster, or questions of government legitimacy), NGOs can submit proposals directly to the Fund.

All proposals must be technically and developmentally sound, must demonstrate that added resources will bring results, and must meet high programmatic and financial accountability standards. The TRP reviews all proposals and makes funding recommendations to the Board. The Board makes all final decisions on grant awards. Priority for funding is given to proposals from countries and regions with the greatest need, including the highest burden of disease and poverty, and those at high risk for disease emergence.

The Fund is committed to the highest standards of financial and programmatic accountability and has established a Board committee on monitoring and evaluation to include financial accountability and audit responsibility. Through the various technical agencies within the U.S. Government we will provide assistance to the Fund to conduct monitoring and evaluation of programs. Over the next year, the Fund will be challenged to move money quickly and responsibly, and report on the results achieved.

^*$100 million in the FY01 supplemental, $200 million in FY02, $350 million in FY03, and the President has pledged to request $1 billion over 5 years starting in FY04.