The Global Fund’s 5th Replenishment: What, Why and How?

Nisa PatelArticle

What is the Global Fund Replenishment?

The Global Fund to Fight AIDS, Tuberculosis and Malaria provides grants to low and middle-income countries to fund prevention, treatment and care programs for people with HIV/AIDS, TB and malaria. In 2003, the Global Fund adopted a three-year replenishment model to assure countries of sustained and predictable financial support for their programs.  The Fourth Voluntary Replenishment resulted in a total of USD 12.418 billion pledged for 2014-2016 programs. The goal for the upcoming Fifth Replenishment covering 2017-2019 programs is set at USD 13 billion.

Why is a fully funded Fifth Replenishment critical?

The Fifth Replenishment is particularly critical because it represents an opportunity to leverage past gains and build upon recent advances to enable countries to achieve the target identified in the new Sustainable Development Goals: ending the epidemics by 2030.  The Secretariat cautions that while we are on the right side of the “tipping point” to control HIV, TB, and malaria, we need renewed investments to safeguard against a resurgence of the diseases. While 2030 may seem far away, experts from UNAIDS warn that investments made within the next five years will determine whether or not our global goals will be met by 2030.

The Global Fund’s goal of USD 13 billion will leverage significant additional funding, including an estimated USD 41 billion from domestic sources in implementing countries. Overall, a USD 13 billion contribution for the Fifth Replenishment would save up to 8 million lives through programs supported by the Global Fund, leading to 30-32 million lives saved cumulatively by 2020; and, would avert up to 300 million new infections across the three diseases. It would also lead to broad economic gains of up to USD 290 billion over the coming years and decades, based on partner estimates on the return on investment for implementing the programs supported by the Global Fund. These estimates assess the economic value of the increased productivity unlocked by improving the health of a society.

How can the private sector make an impact?

Private sector partners are encouraged to participate in Global Fund governance to ensure resources raised in the Replenishment are optimally invested for high impact. Companies can participate at the global level through the Private Sector Delegation to the Global Fund Board or at the country-level through Country Coordinating Mechanisms (CCMs), which provide oversight of and prepare applications for grant programs. The Private Sector Delegation (PSD) to the Global Fund, as one of the twenty Delegations to the Global Fund Board, represents the official governance mechanism for private sector engagement with the Fund. Members of the PSD serve as advocates for the Global Fund’s mission and mandate within their specific industries and provide input on key Global Fund strategies, policies, and procedures through the PSD platform.

Private sector companies can also partner with the Global Fund by contributing directly to the Fifth Replenishment with a one-time donation or monetary pledge for each of the next three years. Private sector organizations, charities and foundations have already pledged USD 37 million to the Global Fund’s Fifth Replenishment, as of January 2016.

Private sector companies interested in local or regional efforts can engage with Global Fund implementers in recipient countries to find opportunities for co-investment, where private sector resources invested alongside of existing Global Fund grants can help scale up services and strategically fill gaps.

Fully funding the Global Fund is a shared responsibility that requires a joint effort of all global health stakeholders, including the private sector.  To date, the Global Fund has received over USD 1.69 billion from private sector partners and foundations, including (RED), Ecobank, Vale, Coca-Cola, SAP, and the Bill & Melinda Gates Foundation. In addition to saving lives, these contributions are investments towards healthy and prosperous populations in emerging economies free from the burden of the three diseases and the creation of new markets with great business potential.

How did the Global Fund set its Fifth Replenishment goal?

The Global Fund set a target of USD 13 billion for the Fifth Replenishment that will support health-related projects in low and middle-income countries in 2017-2019. This amount is derived from the comprehensive needs analysis conducted by technical partners, detailing the gap in resources needed to effectively tackle each of the three diseases.

The Global Fund collaborated with the United Nations Joint Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO), the Stop TB Partnership and the Roll Back Malaria Partnership to estimate the total amount of resources required over the 2017-2019 period to finance HIV, TB and malaria programs. According to the Global Fund Investment Case, the resource need from both domestic and external funding sources for the three-year period, in countries eligible to apply for Global Fund grants, is estimated at US 97 billion. The Global Fund has traditionally funded 20% of the international contribution to the HIV/AIDS response, 80%of the TB response, and 50% of the malaria response; while domestic funding continues the grow, the target of USD 13 billion will ensure continued external investment to maintain and accelerate the gains made against the three diseases.

The Global Fund’s target of USD 13 billion is based on country realities and factors in best practices in program design and delivery, as well as opportunities for the expansion of essential interventions for maximum impact.

What has been the Global Fund’s impact on the three diseases so far?

The Global Fund has 461 active grants in over 100 countries and traditionally channels 75% of the international financing for TB, 50% for malaria and 20% for HIV. Additionally, more than one-third of the Global Fund’s investments go to building resilient and sustainable systems for health, as this is a critically important component to ending HIV, TB and malaria as epidemics.

The Global Fund and its programs have contributed to significant cumulative strides in the fight against the three diseases since its first disbursements were made in 2002, including:

  • 17 million lives saved; on track to reach 22 million lives saved by the end of 2016
  • A decline of one-third in the number of people dying from HIV, TB and malaria since 2002, in countries where the Global Fund invests
  • 1 million people on antiretroviral treatment for HIV
  • 2 million people have received TB treatment
  • 548 million mosquito nets distributed through programs for malaria
Nisa PatelThe Global Fund’s 5th Replenishment: What, Why and How?