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

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 October 2002, governments, corporations, foundations, and individuals had pledged approximately $2.1 billion to the Global Fund. Many of the pledges are multi-year; $700-$800 million is available to disburse to approved grantees in calendar year 2002. The United States has pledged $500 million over two years. The US is the largest contributor, and has thus far provided $275 million of the funds available in 2002. Approved first-round grants total $616 million over two years to 58 projects in 40 countries. The Board will consider a second round of proposals at the January 2003 Board meeting, and is expected to made additional awards at that time.

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 USAID and CDC, 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, formed 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 two groups: nine donors, including seven governments, a foundation representative, and a representative of the for-profit private sector; and nine recipients, including seven governments and two non-governmental organizations, one from the developing world and one from the developed world. The five non-voting members include 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. Secretary of Health and Human Services Tommy G. Thompson is the U.S. representative on the Board. Governance procedures will evolve, and the goal is to have a flexible and innovative management structure. The Board is planning a "Partnership Forum" every two years to gather all stakeholders, including those not presently participating on the Board, and advise the Fund, thus providing additional input and coordinating 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) is charged with reviewing all proposals to ensure that they are scientifically, technically, and developmentally sound. The TRP is composed of an independent group of 22 experts in the three diseases, and in the fields of prevention, clinical care, health education, and health economics.

Grants
Proposals are submitted through an inclusive, broad-based partnership in each country, referred to as a Country Coordination Mechanism (CCM), which brings together national and local governments, NGOs, and the private sector. In countries where a CCM either does not exist, or does not function adequately due to 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. Over the next year, the Fund will be challenged to move money quickly and responsibly, and report on the results achieved.