Ten years ago, and after two decades with little to show for ending the devastating HIV/AIDS scourge, coupled with a reemergence of tuberculosis and malaria in poor countries, former United nations Secretary General Kofi Annan created the Global Fund to Fight AIDS, Tuberculosis and Malaria in poor nations. Kofi Annan wanted a US$7-10 billion per year funding for AIDS alone. The Global Fund is a private-public partnership committed to using the developed world’s funds to create a world free from the ravages of AIDS, tuberculosis and malaria. The model has as its basis country ownership through the country coordinating mechanism (CCM) and performance-based funding, where people in their own countries implement their own projects with their own priorities, and the Global Fund grants funding conditional on verifiable outcomes.

The Global Fund does not have any local offices in any of its 150 recipient countries it services. Nonetheless, the Global Fund has core structures that include the CCM, the Global Fund Secretariat, Technical Review, and the Global Fund Board, with their locations in Geneva. The CCM comprises the main stakeholders in that country’s response to fight AIDS, tuberculosis and malaria. The Global Fund Secretariat expects to manage grant portfolios. The Technical Review Panel comprises international experts in the three diseases, and who offer funding recommendations to the Board. The Global Fund Board comprises representatives from donor and recipient governments, civil society, private sector, private foundations, and communities afflicted with the three diseases.
Donors at the 2010 Third Voluntary Replenishment Conference pledged US$11.7 billion for the 2011-2013 period; this is well below the war chest that Kofi Annan envisaged. At any rate, this replenishment may enable anti-retrovirals to reach 600 million people and may distribute a cumulative total of 500 million insecticide-treated nets by 2015; the United Nations subsequently revised the 6 million figure to 13 million people who would receive anti-retrovirals.
In its 2011-2016 strategy, the Global Fund is focusing on making best use of value for money and broaden its services beyond AIDS, tuberculosis and malaria, to include attending to the Millennium Development Goals in maternal and child health. This strategy raises questions as to the timeliness to expand its mandate, when there is a paucity of funds and where many targets are not being met in the AIDS, tuberculosis and malaria programmes.
The Global Fund applies the principle of performance-based funding, connecting disbursements to outcomes. And between 2005 and 2010, only about 75% of the assessed grants attained their targets. The Global Fund in 2009 granted 21% of international public HIV funding, 65% international tuberculosis funding for the 22 high-burden countries, and 65% of international malaria funding. The Global Fund’s provision of funding per year seems low, particularly in AIDS.
The Global Fund was conceived in the heydays of abundant funding. Since 2008, the international meltdown and the international credit crunch in the developed world have converted abundance into scarcity. Quite recently, U.S. Treasury Secretary Timothy Geithner noted that the global economic recovery is still fragile, due to the steeping oil prices and constant risks from the Euro area.
Against this background of a paucity of funds and the problems of corruption and misappropriation of funds in the developing recipient countries, the Global Fund in February 2012 appointed a General Manager in Gabriel Jaramillo. He already has reduced the Global Fund’s bureaucracy by 40%, with more staff and less bureaucracy.
The General Manager told Sarah Boseley of the Guardian that he has eliminated the two huge departments and replaced them with smaller departments, focusing on small countries and high-risk countries; and enabling timely oversight of their grants, rather than having these countries’ grants being snowed under by countries with huge populations, as happened in the past; under such conditions in the past, the Global Fund did not attend to the many small recipient countries in a timely fashion.  According to Boseley, there are monthly disease-management committees with partners to review improvements, to further integrate recipient countries into the Global Fund’s consultative process.
Apparently, amid the fragile global economic recovery, corruption and misappropriation of funds in the resource-constrained countries, donor confidence has waned. Within this context and in an effort to curb these financial atrocities, Jaramillo has to effect additional reforms in creating local offices in the countries receiving grants, in the same way that the World Bank, the International Monetary Fund, the Inter-American Development Bank , etc. do.
Nevertheless, support for the Global Fund continues to pour in from Spain, Germany, and the Gates Foundation; and the British International Development Secretary Andrew Mitchell will provide US$204 million this year, and U.S. Secretary of State Hillary Clinton remains supportive. General Manager Jaramillo is doing his thing at a fast pace vis-à-vis making the Global Fund a leaner and meaner funding machine. And Jaramillo may provide the new lease of life the Global Fund badly needs. In doing so, Jaramillo and the Global Fund have to quickly reverse the low to moderate public funding for AIDS in poor countries, in order for a larger number of people living with AIDS to have access to anti-retrovirals. Failure to move fast on this front may see an upsurge in HIV infection in those countries.