Global Fund to Fight AIDS, Tuberculosis, and Malaria

The Global Fund is a unique global public-private partnership dedicated to attracting and disbursing resources to prevent and treat AIDS, tuberculosis, and malaria. As a partnership among governments, civil society, the private sector and affected communities, the Global Fund represents a new approach to international health financing.

Since its creation in 2002 and with strong financial support from the USG, the Global Fund has become the main external financing mechanism for programs to fight AIDS, tuberculosis, and malaria. It has approved funding of $18.7 billion for more than 600 grant programs in 144 countries. Worldwide, of all international financing, the Global Fund provides approximately one quarter for AIDS, two-thirds for tuberculosis, and three quarters for malaria.

PEPFAR strongly supports the Global Fund. The United States made the founding contribution to the Global Fund, and remains its largest donor. The USG has contributed more than $4.3 billion to the Global Fund to date, with additional pledges that bring the total USG commitment through fiscal year 2009 to $4.5 billion. In addition to these direct contributions, PEPFAR provides specific technical assistance funding for grant implementation and oversight. By working through the Global Fund, the USG can catalyze contributions from other donors, expand the geographic reach of USG bilateral programs, promote country ownership, and increase the sustainability of national health programs.

The Global Fund model represents an inherently country- owned approach, which fits well with PEPFAR's goal of supporting increased country ownership of national HIV/AIDS programs. This goal is critical to the long-term sustainability of AIDS responses and can be supported through a robust and coordinated multilateral response. PEPFAR is working with both the Global Fund and the UN system to support increased country ownership in a coordinated manner. The Global Fund can provide countries with predictable, performance-based financing, and the UN system has the mandate, country presence, and expertise to build country-level capacity and leadership. Nevertheless, continued USG engagement and support at the country level will be essential in supporting a full transition to country ownership. Consequently, PEPFAR will expand the engagement of its country teams with its country-level Global Fund counterparts and processes.

PEPFAR is also supporting a shift in Global Fund grant architecture. This shift would move it from a project-based approach to a program-based approach supporting comprehensive national responses to AIDS, tuberculosis, and malaria. These reforms are intended to consolidate and rationalize country programs and reporting requirements, harmonize Global Fund financing with country-level fiscal and planning cycles, and reduce transaction costs. By reducing duplication of effort at the country level, both PEPFAR and the Global Fund will enable countries to identify gaps in services, and achieve better value for money.

PEPFAR's long-term goal is to see more management and operation of bilateral programs conducted by the countries themselves, with financial support through the Global Fund. In order to promote this goal, PEPFAR is working to improve grant performance, quality, and consistency of services, and transparent and accountable financial management. PEPFAR is continuing efforts with the Global Fund Secretariat, its Inspector General, and its Board to improve the impact, oversight, and cost-effectiveness of Global Fund grants. Financial and program accountability is paramount to ensuring that PEPFAR funds are effectively leveraged and that, ultimately, programs are successfully implemented.

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