Elsevier

The Lancet

Volume 364, Issue 9428, 3–9 July 2004, Pages 95-100
The Lancet

Public Health
The Global Fund: managing great expectations

https://doi.org/10.1016/S0140-6736(04)16595-1Get rights and content

Summary

The Global Fund to fight AIDS, Tuberculosis, and Malaria was created to increase funds to combat these three devastating diseases. We report interim findings, based on interviews with 137 national-level respondents that track early implementation processes in four African countries. Country coordinating mechanisms (CCMs) are country-level partnerships, which were formed quickly to develop and submit grant proposals to the Global Fund. CCM members were often ineffective at representing their constituencies and encountered obstacles in participating in CCM processes. Delay in dissemination of guidelines from the Global Fund led to uncertainty among members about the function of these new partnerships. Respondents expressed most concern about the limited capacity of fund recipients—government and non-government—to meet Global Fund conditions for performance-based disbursement. Delays in payment of funds to implementing agencies have frustrated rapid financing of disease control interventions. The Global Fund is one of several new global initiatives superimposed on existing country systems to finance the control of HIV/AIDS. New and existing donors need to coordinate assistance to developing countries by bringing together funding, planning, management, and reporting systems if global goals for disease control are to be achieved.

Section snippets

Approach

We are tracking early implementation of the Global Fund in four sub-Saharan African countries: Mozambique, Tanzania, Uganda, and Zambia. Table 1 summarises the burden of disease due to HIV/AIDS, tuberculosis, and malaria in these countries and the outcome of country applications for Global Fund support. We selected these countries on the basis of high burden of disease and poverty, submission of proposals to the Global Fund in round one, support from senior government officials, and study

Participant's views

After three application rounds, all four countries were approved for high levels of support to fight the three diseases (table 1). Despite the positive effect that additional money could have on resource-starved systems, the Global Fund received a mixed welcome in these countries. Governments and non-governmental organisations (NGOs) were most positive. For example, a government respondent in Zambia reported that “the beauty of the process from a country perspective is that it is country led.

Early lessons

The Global Fund is an evolving initiative, which has made a major financial commitment to help countries to tackle HIV/AIDS, tuberculosis, and malaria. Still at an early stage, it is too soon to estimate its effectiveness. Rapid learning and applying lessons to get country-level processes right, are essential to achieving the Fund's goals. For example, the Fund now acknowledges that countries operating sector-wide approaches were not always clearly informed that this was a channel through which

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