Written evidence submitted by the Global
Fund
1. The Global Fund to fight AIDS, Tuberculosis
and Malaria (TGF) is an international health financing mechanism
dedicated to attracting and disbursing additional resources to
prevent and treat HIV/AIDS, Tuberculosis and Malaria. Created
in 2002, as a public private partnership it has to date committed
US$ 15.6 billion in performance based program funding for approximately
140 countries. To date, the Global Fund supported-programmes have
saved 3,000 lives a day. 2.3 million people are under ARV treatment.
5.4 million are receiving effective TB treatment, and the Global
Fund is an sole financier of Extreme Drug-Resistant TB programs.
Evidence from several malaria endemic countries shows declines
in malaria cases and child mortality of up to 50% where high coverage
of effective prevention and treatment has been achieved, including
in Rwanda, Zanzibar, Eritrea and Burundi. The Global Fund plays
also a critical role in harm reduction and TB treatment being
the largest or sole financier.
2. The Global Fund welcomes the opportunity
to provide evidence and information on the implementation of the
UK strategy for halting and reversing the spread of HIV in the
developing world. As a financing institution that relies on its
many public, private and civil society partners for program implementation,
the Global Fund has no field representation. Thus it can report
primarily on how DFID's active engagement in the Global Fund Board
and Committees have contributed to the Global Fund's operational
policies and funding decisions and less on how the strategy is
being implemented at the country level.
3. The technical leadership and financial
support that the UK has provided to the Global Fund since its
inception in 2002 should be underlined. It is the third largest
donor to the Global Fund having contributed £ 414 million
(or US$ 660 million) up until the end of 2008. Under a long term
Memorandum of Understanding (MOU), the UK has pledged a further
£1 billion for the period 2009-15, of which £115 million
has already been received. This represents a strong commitment
to the Paris Declaration on Aid Effectiveness and the Strategy's
objective of "providing long-term, performance-based and
predictable resources to countries and partners in support of
a sustainable global response to AIDS beyond 2010". DFID
is working together with the Secretariat of the Global Fund to
explore methods to achieve further multi-annual pledges from other
donors.
4. In line with its approach to multi-year
funding, the above UK pledge is conditional upon evidence of high
quality demand, strong performance and sustainable impact. This
approach is very much in line with several of the founding principles
of the Global Fund as regards transparency, accountability and
performance based funding. Under the MOU, a logical framework
is being finalised based on agreed key performance indicators
that will allow verification that the conditions for the UK pledges
have been met. The MoU has also led to a commitment for reinforced
cooperation between DFID and the Global Fund at the country level
in search of greater efficiency gains.
5. While the financial support and the predictability
it provides has been greatly appreciated, the UK's contribution
to the Global Fund's policy agenda has been equally valuable and
follows many of the objectives set out in the strategy. Some of
the main contributions are listed under the relevant issues below.
Progress on Health Systems Strengthening (HSS)
and on an integrated approach to HIV/AIDS funding
6. DFID has been a vocal supporter of HSS
in the Global Fund Board and the Fund remains committed to providing
resources for HSS. To date, some US$ 4.2 billion or 35% of TGF
funding has been invested into HSS efforts in support of the fight
against the three diseases through two different mechanisms, either
through grants in single disease areas or through cross-cutting
HSS section attached to a disease proposal.
7. DFID has been extremely supportive of
the ongoing discussions between the World Bank, GAVI and the Global
Fund, which aim to better align the respective HSS frameworks.
This would allow for joint HSS funding and programming in support
of nationally owned development plans.
8. The Global Fund is a strong supporter
of the International Health Partnership (IHP) mechanism and has
signed the IHP Global Compact. The Global Fund is an active participant
in the HIP Scaling-up Reference Group and contributes also to
the working group on National Strategy Application (NSA) and to
the one on Monitoring and Evaluation. The Global Fund has adopted
the Paris Declaration on aid effectiveness and is measuring itself
against the Declaration targets. In that spirit, the Global Fund
is currently piloting funding of NSA, applications based on National
Strategies validated by civil society and development partners
in the field. It also continues to working on improving harmonization
and alignment through the review of its architecture for a simplified
and greater alignment which should be implemented starting 2010.
Integration of HIV/AIDS prevention, treatment
and care with other disease programmes, particularly tuberculosis
and malaria
9. As a co-signatory of the Paris Declaration,
the Global Fund has adopted the performance indicators on harmonization
and alignment, including the conclusion of TGF funded programs
into National Budgets. This is a critical step to ensure integration
with National Health Plans.
Progress on work involving marginalised and vulnerable
groups
10. DFID highlights the need for priority
actions for the empowerment of people living with HIV and promotion
of the rights and care of marginalised and vulnerable groups.
In relation to the Global Fund, this commitment has been evident
in the Board discussions on the "Gender Equality Strategy"
and "Sexual Orientation and Gender Identity Strategy"
(SOGI). Following their approval in November 2008 and May 2009,
respectively, the Global Fund has been working on implementation
plans and will shortly begin concrete activities.
11. Those two strategies were elaborated
to encourage a positive bias in funding towards programs and activities
that address gender inequalities and strengthen the response for
vulnerable and marginalised groups, including addressing needs
of women and girls, men who have sex with men (MSM), transgender,
bisexual, and lesbian populations.
12. In 2008, the Global Fund has made further
efforts by including gender related questions in the forms and
guidelines to countries wishing to submit proposals for Global
Fund financing. Some UN agencies, Civil society organisations—including
those supported by DFID and other bilateral organisations, assisted
countries to target gender related issues in their proposals such
as Sexual and Reproductive Health and HIV integration for better
and effective access to prevention service. The Global Fund has
also increased the number of harm reduction proposals for injection
drug users and is now the largest supporter of harm reduction
intervention in the world with nearly US$ 900 million committed
to grants that include harm reduction.
Progress towards the commitment to universal access
to Antiretroviral Treatment (ART) and its impact on the effectiveness
of care and treatment, particularly for women
13. By end 2008, the Global Fund supported
comprehensive AIDS treatment programmes in 137 countries. It is
a major contributor to treatment scale-up, presently supporting
around 50% of all people on antiretroviral treatment globally,
around 50% of those on treatment in Africa and, if Thailand is
excluded, about 75% of those on treatment in Asia. ART coverage
in low and middle-income countries stood at 42% of a total of
9.5 million people in need, up from 33% at end 2007. Coverage
was slightly higher among adult women (45%) compared to adult
men (37%). At the end of 2008, an estimated four million people
were receiving ART worldwide, half of them through the Global
Fund's investments.
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