Bill & Melinda Gates Foundation

The Global Fund: Saving More Lives with Every Dollar

March 11, 2013

Recently, the Global Fund to Fight AIDS, Tuberculosis and Malaria – which has saved millions of lives around the world over the past decade – launched a new funding model to further strengthen the impact of every dollar that it delivers to families and communities around world. To better understand the new funding model and how it will enhance the Global Fund’s human impact, we spoke with Deb Derrick, President of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, the leading U.S. advocate for the Global Fund.

At the 50,000-foot level, can you explain what the Global Fund’s new funding model is?
It’s a significant milestone for the Global Fund and its innovative approach to health investments. The new funding model applies the lessons that we’ve learned from science and epidemiology over the past decade about the best approaches to fighting AIDS, TB and malaria so that the Global Fund can work with countries to improve service delivery and results. The bottom line is to help more people get access to effective treatment and prevention.

What’s “new” about the new funding model?
Historically, the Global Fund awarded grants in “rounds.” This mean that, at specific times in the year, the Global Fund would review a large number of previously unseen proposals.  The new funding model has a more flexible and open-ended approach to grant-making by:

  • Allowing countries to apply for and receive grants according to their own timelines and national planning cycles, rather than just when a funding window is open; and
  • Facilitating a more collaborative process. Country and Global Fund representatives, along with civil society and local disease experts, will discuss and negotiate the most appropriate ways to address the unique dimensions of local epidemics on the ground before proposals are sent to Geneva for consideration.

In sum, the new funding model encourages countries – and their health experts and health advocates -- to more clearly define the technical support and funding they need to maximize their response to the three diseases.  The process also provides countries with clear early indicators about how much funding they are likely to be awarded, which helps improve planning.

What are the benefits of the new model?
The key features of the Global Fund’s new funding model are:

A flexible timeline.
Eligible countries may apply at any time during the three-year allocation period so that funding can be more in line with national budgeting cycles and country-specific demands.

 Simplicity. A more streamlined “concept note” begins the process of applying for a grant.  This document contains the statement of need as well as the budget and framework for the initiative for which funds are being requested. Through dialogue and development, this document ultimately becomes the grant application.

 Predictability. All eligible countries are told how much money can be made available to them. The amounts are adjusted to account for implementers’ circumstances.

 Focus on high-disease-burden and low-resource areas. The new model allows the Global Fund to focus on countries with the highest disease burden and least ability to pay. In other words, it is designed to maximize impact.

Enhanced engagement. Global Fund representatives will engage more proactively in ongoing country-level dialogue, and provide feedback prior to the Board’s official consideration of grants. This iterative process is designed to increase the rate of successful applications, support higher-impact investments, and ensure disbursements happen quickly when grants are signed.

You mention simplicity, predictability, and enhanced engagement, among other positives of the new model. How does the Global Fund envision these benefits playing out on the ground?
The new funding model allows for input from all of the actors who are critical to success – from disease experts, to finance experts, to country leaders, to the civil society and faith-based organizations that will deliver services to the people who need them. This value-added input increases potential impact at the local and community level.

The Global Fund will also work with partners to strengthen national strategies that incorporate HIV/AIDS, tuberculosis and malaria treatment and prevention efforts into a holistic, patient-centered approach.  This process will ensure that funding for HIV, TB and malaria helps to strengthen the overall performance of essential health services, and it will help countries identify where they should increase their own health budgets.

Who is eligible to apply?
Six countries were invited to participate in the first stage of the new funding model - Zimbabwe, El Salvador, Myanmar, the Democratic Republic of the Congo, Kazakhstan and the Philippines. These six were chosen because they are:

  • Positioned to achieve rapid impact
  • At risk of service interruptions
  • Relatively underfunded
  • Diverse in areas such as size, geography, and health system capacities, so that lessons learned can be applied to future grant-making.

The new funding model also includes three multi-country initiatives: two aimed at catalyzing a coordinated response to malaria in key geographies and one focused on reducing AIDS transmission within high risk groups.

It is worth noting that the bulk of available funds will be directed toward 47 countries that may receive up to $1.5 billion through renewals, grant extensions and redesigned programs. As “interim applicants,” these countries can immediately accelerate ongoing and effective programs.

For all other countries – “standard applicants” – the new funding model’s flexible timeline means that countries can begin discussing future grants with the Global Fund throughout 2013, in preparation for the 2014-2016 funding period.

With only six countries being invited to participate in the NFM in 2013, how are other Global Fund grant recipients affected?
The Global Fund continues to make great inroads in the fight against HIV/ AIDS, tuberculosis, and malaria in places with the highest disease burden and fewest resources. Although in the near term only a few countries will go through the full new funding model process, Global Fund grants are already in place and continuing all over the world. The lifesaving work that partners are doing right now on the ground with Global Fund support will continue simultaneously with the rollout of this new funding model.

The Global Fund will apply the learnings of these six “early adopters” as it ramps up to full implementation in late 2013, once the level of available funding for the 2014-2016 cycle has been established. As Global Fund Executive Director Mark Dybul recently said, the new funding model provides a chance to learn and adapt. The process will be closely monitored so that course corrections can be made in real time. The Global Fund is a learning institution and it will gain insight and knowledge by collaborating with these specific countries, while continuing its support of ongoing grants across the globe.

 
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