How the Global Fund Works

The Global Fund to Fight AIDS, Tuberculosis and Malaria was created to dramatically increase resources to fight three of the world's most devastating diseases, and to direct those resources to areas of greatest need.

As a partnership between governments, civil society, the private sector and affected communities, the Global Fund represents an innovative approach to international health financing.

Global Fund's General Principles

l         Operate as a financial instrument, not an implementing entity.

The Global Fund's purpose is to attract, manage and disburse resources to fight AIDS, TB and malaria. We do not implement programs directly, relying instead on the knowledge of local experts.

As a financing mechanism, the Global Fund works closely with other multilateral and bilateral organizations involved in health and development issues to ensure that newly funded programs are coordinated with existing ones. In many cases, these partners participate in local Country Coordinating Mechanisms, providing important technical assistance during the development of proposals and implementation of programs.

The Global Fund is committed to relying on existing financial management, monitoring and reporting systems, where possible.

l         Make available and leverage additional financial resources.

The Global Fund only finances programs when it is assured that its assistance does not replace or reduce other sources of funding, either those for the fight against AIDS, tuberculosis and malaria or those that support public health more broadly. The Global Fund actively seeks to complement the finance of other donors and to use its own grants to catalyze additional investments by donors and by recipients themselves. In several countries, governments or other organizations have already increased their support to programs that fight these three diseases, validating the Global Fund's ambition to increase overall investment in health.

Since 2001, the Global Fund has attracted US$ 4.7 billion in financing through 2008. In its first two rounds of grant-making, it has committed US $ 1.5 billion in funding to support 154 programs in 93 countries worldwide.

This substantial infusion of resources will enable many countries to scale up existing programs to a level commensurate with need. Still others will initiate new programs where none existed due to a critical shortage of funds. In future years, the Global Fund's ability to support the expansion of proven interventions will depend entirely on its ability to raise additional funding.

l         Support programs that reflect national ownership.

The Global Fund encourages new and innovative alliances among partners within recipient countries and seeks the active participation of local representatives of civil society and the private sector. By focusing upon the technical quality of proposals, while leaving the design of programs and priorities to partners reflected by the Country Coordinating Mechanism, the Global Fund also encourages local ownership.

This approach serves not only to drive effective disease-specific strategies but also to support efforts to strengthen underlying health systems in recipient countries, consistent with national strategic plans. Programs underwritten by the Global Fund build upon existing poverty-reduction strategies and sector-wide approaches that have been developed to improve public health.

l         Operate in a balanced manner in terms of different regions, diseases and interventions.

In awarding grants, the Global Fund gives priority to effective proposals from countries and regions with the greatest need, based on the highest burden of disease and the fewest financial resources available to fight these epidemics. The Global Fund also supports grants in areas of the world with emerging epidemics, in an effort to avert further disaster. For example, a grant to Ukraine will help establish a system to provide HIV antiretrovirals, beginning a dramatic scale - up of treatment through an innovative partnership between the government and nongovernmental organizations.

The Global Fund is financing programs in all regions of the world. However, in recognition of the disproportionate impact of these diseases in Africa, 61% of funds approved in Rounds 1 and 2 will fund programs in sub-Saharan Africa. Nearly two-thirds of funds approved in these two rounds are for AIDS, with 17% and 14% for malaria and TB, respectively.

Pursue an integrated and balanced approach to prevention and treatment.

The Global Fund takes a comprehensive approach to AIDS, TB and malaria, funding both prevention and treatment based on locally determined needs. Three-quarters of countries awarded HIV/AIDS funds will use at least a portion of their grants to provide antiretroviral treatment. All HIV grants include prevention activities, most often focusing on young people who comprise 40% of all new infections worldwide. Grants for malaria will both expand access to insecticide-treated bed nets and give health officials the tools and training to identify, diagnose and treat people who are ill. In the case of TB, in particular, providing effective treatment has the added benefit of preventing the further spread of the disease.

  Evaluate proposals through independent review processes.

The Global Fund's use of and independent Technical Review Panel ensures that limited resources are targeted to technically sound programs with the greatest chances of success. The panel includes disease experts, as well as experts in the field of development who are able to assess how proposed programs complement ongoing health and poverty reduction efforts at the country level.

Proposals are first screened for eligibility by the Secretariat and are then forwarded to the Technical Review Panel which assesses proposals for technical merit and consistency according to proven best practices. Through this review process, proposals are divided into four main categories: (1) ready and appropriate for funding; (2) appropriate for funding following a limited number of clarifications; (3) not appropriate for funding in the present round, but revision and resubmission is recommended; and (4) not appropriate for funding. The Board then considers the recommendations made by the Technical Review Panel and approves proposals in categories (1) and (2) based upon the availability of funds.

The Technical Review Panel, while applying even more rigorous standards in the second round than the first, perceived that proposal quality had improved, following significant investments by countries in the development of proposals, often with important input by technical partners.

Establish a simplified, rapid and innovative grant-making process and operate transparently, with accountability.

While the concept of performance-based grant-making is not new, the Global Fund is pioneering practical systems to implement this approach that balance the need for accountability and efficiency. This includes working with recipient countries to identify a small number of key indicators to be used to measure progress, and ensuring that, where possible, Global Fund reporting requirements rely on existing processes. The use of Local Fund Agents is another accountability mechanism designed to provide appropriate oversight while respecting local implementation.

The Global Fund's commitment to transparency is illustrated by the broad range of information available on this website. All approved proposals and signed grant agreements are available for review in unedited form, as are documents discussed at Board meetings.

The public is now able to track the progress of local programs by reviewing ongoing grantee reports.