The Global Fund to Fight AIDS

While donor funding for health in low and middle-income countries rose significantly in the last decade, the era of rapid growth has come to an end. Health increased as a share of Official Development Assistance (ODA) during the early part of the past decade, largely spurred on by the creation of several new funding initiatives and mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). However, this share has remained essentially flat in recent years, with year-to-year increases in donor funding for health peaking in 2007, and declining each year since.

UNAIDS and the Kaiser Family Foundation have been tracking donor government assistance for AIDS in low- and middle- income countries since 2002. This latest report provides data from governments for 2011, the most recent year with comparable data available across donors. As it shows, international assistance rose sharply from 2002 through 2008, the period just before the onset of the economic crisis. It then began to flatten and, last year, for the first time, disbursements declined. The current report finds that although funding has gone back up, it remains at 2008 levels. If such trends continue, reaching the UN Political Declaration investment target of $22-24 billion needed by 2015 could be at risk.

Over the course of 2011, the Geneva-based Global Fund to Fight AIDS, Tuberculosis, and Malaria experienced unprecedented adversity. Media accounts and internal reports drew attention to instances of corruption involving grantees: $34 million of probable fraud in four African countries triggered a suspension of assistance by Germany and two other European donors. External reviews detailed the Fund’s deficient managerial practices, weak oversight of investments, and ineffectual board governance. An alarming, $2-billion-plus financial shortfall, revealed suddenly at year’s end, reflected a worsening global economy, overly optimistic forecasting by the Fund secretariat, and flagging donor trust and confidence in the Fund itself.