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Global Health Policy Blog


Everyone from the UK Parliament to the President of the World Bank to Warren Buffett knows that spending money wisely is harder than raising it. So in all the excitement about the new monies for much-needed drugs that will be raised through UNITAID, the new French-led funding source fed largely by airline taxes, who is worrying about how the resources will be spent? An obvious way to use the funds would be to ship them off to the Global Fund to Fight AIDS, TB and Malaria, but, as Amb. Jimmy Kolker said in his comment about UNITAID last week, under the current plans the funds will NOT go to the Global Fund either in drugs or cash; the Global Fund may not accept drugs, and I'm speculating that the Board of UNITAID doesn't want to risk giving large sums of money to an entity to do something it simply doesn't know how to do yet at global scale -- procurement. This is an excellent example of the identity crisis the Global Fund faces as it consolidates its role as a major player in the fight against HIV/AIDS. Can the Global Fund be a financing mechanism and only just that?

The Global Fund defines itself as a financing entity -- it finances proposals created by others who define their own needs and design strategies to respond to those needs for HIV/AIDS, TB and Malaria. While a hands-off approach to financing global HIV/AIDS programs is desirable in global development, especially in the spirit of moving from "donorship" to "ownership," some countries just do not have the local capacity to implement all their programs. This challenge is pushing the Global Fund to rethink their financing only role, particularly in the area of procurement. Strong market incentives (besides lack of local/country capacity) are also pulling the Global Fund into the procurement game because it has potential to be a key player in forecasting the demand for ARVs and other drugs, and reducing the risks faced by suppliers.

With both push and pull incentives to move in to the implementation realm, the Board of the Global Fund is clearly debating its options. The decision point around facilitating pooled procurement from the minutes of the last board meeting suggest that possible strategic models for centralized procurement will be proposed at the Fourteenth Board Meeting in November. As the Board deliberates these changes, the Global Fund must develop a more nuanced approach to providing "funds +," where the + refers to additional inputs for the successful implementation of financed proposals. Depending on each country's capacity, this may be for the procurement of drugs and other commodities or for substantive technical assistance, to name a few implementation challenges. Surely, the Global Fund is thinking about transforming itself into more than just a financing mechanism as it begins to address these challenges.

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CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.