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Africa: Global Fund Progress Report

AfricaFocus Bulletin
Sep 9, 2005 (050909)
(Reposted from sources cited below)

Editor's Note

"While the latest progress report points to a steady improvement in results and a persistent trend of a high-performing grant portfolio, it stresses that the Global Fund needs to sharply increase the rate of program acceleration in the next four years if it is to achieve its five-year targets." - Press Release from the Global Fund to Fight AIDS, Tuberculosis and Malaria, August 23, 2005.

At the "replenishment meeting" in London for the Global Fund, concluded on September 6, donors said they had pledged a total of $3.7 billion for the Fund's budget in 2006 and 2007, of which $3.3 billion was tallied in specific pledges. This is only 43% of the amount projected to be needed, despite an international NGO appeal for full funding circulated during August and signed by over 500 organizations in 87 countries (see

This AfricaFocus Bulletin contains the August 23 press release from the Global Fund on the Fund's progress report and excerpts from a news report in the Global Fund Observer on the results of the pledging meeting. The Global Fund Observer is an independent newsletter ( Additional information from the Global Fund is available at the Fund website

According to figures compiled by the Global Fund Observer, based on NGO proposals for "fair-share" contributions by donors, the U.S. pledge in London for 2006-07 came to 23% of its fair share. Europe as a whole pledged 55% of its fair share, and other countries pledged 45% of their fair share. The highest percentage pledges were from France (94%) and the UK (92%).

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

Global Fund to Fight AIDS, Tuberculosis and Malaria

Press Release

23 August 2005

Global Fund Programs Exceed Targets

[Text only: press release including graphs available at]

Further information, please contact:

Rosie Vanek The Global Fund (Geneva, Switzerland) Phone: + 41 22 791 5951 Mobile: + 41 79 445 14 85

Jon Liden The Global Fund (Geneva, Switzerland) Phone: + 41 22 791 1723 Mobile: + 41 79 244 6006

300 Programs Drive Global Scale-up Against AIDS, TB and Malaria

103% of AIDS treatment targets achieved; 156% of Malaria Treatment Targets

Fragile States Fare Better Than Expected

Geneva - Three years after its creation, the Global Fund to Fight AIDS, Tuberculosis and Malaria is proving to be a key engine behind the scale-up of the fight against the three pandemics worldwide. Despite an average age of only 15 months, Global Fund-financed programs support 220,000 people on AIDS treatment and have provided treatment for 600,000 patients with TB and 1.1 million patients with malaria. These results are ahead of mid-year targets for 2005.

The Global Fund currently contributes a fifth of all external resources worldwide to fight HIV/AIDS, two-thirds of all external resources against TB and well over half against malaria.

An analysis of the Global Fund's grant portfolio shows that of the 74 grants that have reached 18 months of age, 80 percent have met or exceeded targets and that taken as a whole, the 74 grants have exceed all targets except those for the distribution of insecticide-treated bed nets (ITNs).

A separate analysis of grants to "fragile" states (defined as states that "cannot or will not deliver core functions to the majority of [their] people, including the poor") shows that grants to such states perform only marginally less well than grants to other low and middle-income countries.

"It is extremely gratifying to see that our grant portfolio is doing well - even better than expected," said Dr Carol Jacobs, the Chair of the Global Fund's Board. "It indicates that the Global Fund's financing structure, which lets countries design and implement their own programs and which rewards good performance, works even in countries that traditionally are not able to use external financing well."

Headline Results

                              June 2005 Dec. 2004      Increase 
People on ARV treatment       220,000   130,000        69% 

TB: People treated under DOTS 600,000 385,000 56%

Malaria: Insecticide treated nets distributed or re-treated 3,100,000 1,350,000 130%

"We are financing programs to most of the world's poorest countries, and the health sector traditionally receives the smallest part of these countries' budgets," said Professor Richard Feachem, the Executive Director or the Global Fund. "Starved of educated personnel and infrastructure, these countries are rarely well prepared to turn large new resources into results quickly. The fact that these programs have achieved substantial results after such a short time is a tribute to the tremendous efforts made by thousands of health workers operating under extremely difficult conditions."

The analysis published today is the third in a series of reports on Global Fund performance. The full text of "Sustaining Performance, Scaling Up Results: Third Progress Report 2005" is available at rdreplenishment.pdf.

"The Impact and Results of the Global Fund Model: Aid in Fragile States" is available at dreplenishment.pdf .

While the latest progress report points to a steady improvement in results and a persistent trend of a high-performing grant portfolio, it stresses that the Global Fund needs to sharply increase the rate of program acceleration in the next four years if it is to achieve its five-year targets..

Annual targets have been set - based on grant agreements - for the scaling up of Global Fund-supported grant activities in order to reach 1.6 million people with ARV treatment for AIDS and 3.5 million people with TB treatment, and to distribute or re-treat 108 million ITNs to protect families from malaria over the five-year lifespan of all grants approved to date. If these targets are reached, this will increase global coverage two or more times from current levels.

While most programs financed by the Global Fund have a five-year time-frame, the Global Fund initially commits funds only for the first two years. Continued funding depends on performance towards agreed-upon targets, measured when the grants have been in operation for 18 months. Grants are graded according to their performance, and decisions on continued funding are taken based on the performance-grading combined with an assessment of contextual information. So far, 70 of the 74 grants that have gone through this process have received commitments of continued funding for years three through five ("Phase 2"); one has been terminated and three are still under consideration by the Global Fund Board.

Nineteen of the 74 grants assessed for Phase 2 funding were from fragile states. While the analysis cautions that this sample size is too small to draw strong conclusions, it indicates that the incentives of performance-based funding and innovative collaborations between public and private sectors are factors that have led to successful performance of grants in states where such performance is unexpected. The study of grants from fragile states will continue as the number of grants that undergo Phase 2 review increases. One-third of the Global Fund's total portfolio of US$ 3.7 billion has been committed to states determined to be fragile.

The Global Fund Portfolio

Global Fund grants enable countries to scale up their fight against the three diseases in a sustainable way by strengthening health systems and paying for drugs, diagnostics, mosquito nets and other commodities.

The Global Fund has allocated US$ 3.1 billion for the first two years of 316 programs in 127 countries with a total five-year value of US$ 8.1 billion. Of the US$ 3.1 billion committed over the first two years, 56 percent goes to fight HIV/AIDS, while 13 percent goes to fight TB and 31 percent to malaria. Sixty percent is spent in sub-Saharan Africa.

A total of US$ 1.4 billion has been disbursed to programs so far.

Expenditure targets for Global Fund grants are 49% for drugs and related supplies, 20% for human resources, 13% for physical infrastructure, 6% for monitoring and evaluation, 7% for administration and 5% for other purposes.

Projected Outcomes over Five Years

The following are the projected outcomes of programs financed by the Global Fund over their five-year life-spans. The programs are on track to reach these targets set for HIV/AIDS and TB, but are behind on targets for malaria. A substantial effort is underway to ensure that malaria targets are reach by the end of the programs' lifetime.


  • 1.6 million people on antiretroviral treatment, a six-fold increase over current coverage in developing countries
  • 52 million clients reached with voluntary counseling and testing services for HIV prevention
  • More than one million orphans supported through medical services, education and community care (only Rounds One through Three)


  • 3.5 million additional tuberculosis cases treated successfully under the DOTS treatment strategy after case diagnosis
  • Quadrupling of treatment of multidrug-resistant tuberculosis, with more than 12,000 new treatments


  • Delivery of 145 million artemisinin-based combination drug treatments for resistant malaria
  • 108 million bed nets financed to protect families from transmission of malaria


Global Fund-financed HIV/AIDS programs are aiming to build up a sustainable effort to turn the tide of the HIV/AIDS pandemic and stop it in its tracks where it is still in its early stages. Resources from the Global Fund therefore go to a wide range of activities, from training and infrastructure strengthening to expand testing, treatment and care to large-scale prevention programs, and care and support for orphans.

To date, 397,000 children orphaned by AIDS have been provided with social, medical and educational support. More than 2.5 million people have been tested for HIV and received counseling through Global Fund-financed programs, tens of millions have been reached through a wide range of prevention programs - from condom distribution and targeted support for injecting drug users and sex workers to behavior change programs and information provided through the media, schools and the entertainment industry.

AIDS treatment: A Joint Effort

Of the HIV/AIDS grants, one half of the money is dedicated towards treatment and care, while the other half is financing prevention activities and HIV testing. Global Fund grants finance HIV/AIDS treatment in over 100 countries and to date have supported national programs that provide ARV treatment for 220,000 people with a goal of reaching 400,000 by the end of the year.

The scale-up of AIDS treatment is a truly collaborative effort, where donors, international organizations and non-governmental organizations all play critical supporting roles in the impressive national campaigns of many countries to roll out treatment - often under extremely difficult circumstances.

International partners, including UNAIDS, the World Bank, the Global Fund, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the World Health Organization met in December 2004 to agree on a methodology to provide consistent international figures in support of the goal of bringing three million patients on treatment by 2005. The figures released today follow this methodology.

Together, the Global Fund and PEPFAR are the major financial engines to achieve greatly increased treatment numbers over the coming years. In 15 countries, Global Fund grants and PEPFAR are supporting different parts of the same national scale-up efforts.


Tuberculosis grants are financing national efforts in high-burden countries to reach globally agreed targets for detection and successful TB treatment. Global Fund grants are also paying for a quadrupling of patients having access to expensive drugs for multi-drug-resistant TB.

So far, just over 600,000 people have received treatment under the DOTS strategy for TB control thanks to Global Fund financing. In addition, multidrug-resistant TB treatment has increased greatly through Global Fund projects, which until now has been too costly for most countries to provide.


The Global Fund is the single largest financier of malaria-related activities globally, with financed activities focused on priorities set by the Roll Back Malaria Partnership. Funding has been predominantly invested in financing a change to new, more effective malaria drugs and providing insecticide-treated mosquito nets throughout regions with high malaria incidence. Substantial amounts are also spent on strengthening national malaria programs through improving staffing, training and infrastructure.

To date, 1.1 million people have been reached with malaria treatments (227,000 of them have received new and effective ACT treatment for drug-resistant malaria) and 3.1 million nets have been distributed. These numbers are expected to continue to rise rapidly over the coming months provided that supply-side problems with the new malaria drugs and the long-lasting pre-impregnated insecticidal nets can be overcome.

The Global Fund is a unique global public-private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria. This partnership between governments, civil society, the private sector and affected communities represents a new approach to international health financing. The Fund works in close collaboration with other bilateral and multilateral organizations to supplement existing efforts dealing with the three diseases.

Apart from a high standard of technical quality, the Global Fund attaches no conditions to any of its grants. It is not an implementing agency, instead relying on local ownership and planning to ensure that new resources are directed to programs on the frontline of this global effort to reach those most in need. Its performance-based approach to grant-making is designed to ensure that funds are used efficiently and create real change for people and communities. All programs are monitored by independent organizations contracted by the Global Fund to ensure that its funding has an impact in the fight against these three pandemics.

Global Fund Observer

7 September 2005

Replenishment Meeting Falls Short of Expectations

Governmental donors yesterday [September 6] pledged $3.7 billion to the Global Fund. This commitment, which fell short of expectations, will be sufficient to pay for grant renewals during 2006+7, and also for the anticipated 2005 shortfall, but will not cover the cost of any new Rounds.

The Global Fund has in the past conducted its fundraising by encouraging donors to give what they can, when they can. Then, in an attempt to bring more predictability to the process, the Fund decided to hold a three-part "Replenishment" meeting every two or three years. The first Replenishment ended yesterday in London.

The Fund had called upon donors to pledge $3.4 billion to cover grant renewals during 2006+7, $0.4 b. to cover the anticipated 2005 shortfall, and $3.7 b. to cover the cost of launching Rounds 6, 7 and 8 during 2006+7, for a total of $7.5 b. Until recently, the Fund had expected to raise well over $4 billion at this week's meeting, but at $3.7 billion, it fell somewhat short of that. "We come out of this replenishment with a whole lot less money than we would have liked to see," said one donor.

Fund officials put a brave face on the outcome, saying that this is "a solid base on which to build," and pointing out that the donors decided to hold an additional meeting next June, by which time it is hoped that sufficient new pledges will be obtained to permit the launching of further Rounds of grants.

In the Fund's first two years, 2002-3, pledges to the Fund totaled $1.8 b. Then in the next two years, pledges increased to $2.9 b. So with pledges for the third two years currently standing at $3.7 b., and certain to climb further, the Fund is still on a steady growth path. However, now that many grants are coming to the end of their first two years and need to be renewed, the Fund's growth is not proving fast enough to permit new grants to be launched at the rate they were earlier.

"Contributions to the Global Fund should not be based on voluntary pledges," said Dr Mohga Kamal Smith of Oxfam. "Funding should be predictable and based on countries' fair shares."

The largest pledge made for 2006+7 was by France, at $658 million. Next came the US, at $600 m., followed by Japan, at $500 m. However, the US pledge is almost certain to be increased by Congress later this month.

The $3,100 million in pledges for 2006+7 by non-US donors puts the US in a somewhat difficult position. The US has said for some time that it will provide "no more than a third" of the Fund's income; but many US officials, including a number of Republican lawmakers, regard the one third as a goal, not just a cap. Yet if the US is to continue to provide one third of the Fund's income, it will have to increase its total pledge for 2006+7 from $600 m. to $1,550 m.

During yesterday's meeting, one particular discussion item ended up taking far more time - over an hour - than any other. This was the question of whether, in the communiqu‚, the single sentence that mentioned the UNAIDS/WHO estimate on how much money needs to be spent globally on tackling the three diseases should appear in the main text or should be relegated to a footnote. As we go to press, the communique has still not been finalized; nor has the list of how much was pledged by each country

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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