The Global Fund at five: what next for universal access for HIV/AIDS, TB and malaria?

Abstract

In 2001 the G8 committed to the creation of the Global Fund to fight AIDS, Tuberculosis and Malaria (the Global Fund) as an independent financing agency to attract, manage and disburse funds from a wide range of donors, including bilateral, multilateral and private sector organizations. With its focused financial appeal for the three diseases which account for over 6 million deaths per year and widespread political support, the Global Fund in its first five years has raised and disbursed an unprecedented volume of resources.1 Its ability to make grants in nearly all developing countries, its operational capacity to move swiftly and transparently in approving project proposals, its direct involvement with civil society, and continuing capacity for critical introspection have led to impressive successes at the country level between 2001-2006.2 As many had hoped at its inception, the Global Fund has become one of the most potent weapons to halt HIV, tuberculosis and malaria among the world's most marginalized populations. Yet, at the end of five years, both the Global Fund as well as many of us who have keenly followed its progress are aware that this organization stands at a critical juncture, facing important questions over its future directions. Some of these concerns arise from lessons learnt from the Global Fund's past experience. Others are catalyzed by the pressures imposed and opportunities provided by the evolving global health environment. The most important of these opportunities is the country level commitment world over to move towards universal access for prevention, treatment and care for HIV prevention, treatment and care. Proposed access to treatment for AIDS was contested as late as 2002, at the launch of the World Health Organization's (WHO) ‘3 by 5’ initiative. At the beginning of this year, thousands of people across the world, from all walks of life, argued for universal access to HIV prevention, treatment and care.3 This sea change in attitudes has brought the AIDS response to a unique historical juncture. Exceptionally, multiple elements necessary for effective scaling-up, including political commitment, broad-based societal involvement, and advanced knowledge of the epidemiological and sociological pathways of the disease, stand primed for action. All eyes are now focused on the leadership and support the Global Fund will provide to drive forward the universal access agenda. Beyond the obvious and important potential role of providing predictable and sustainable financing, the Global Fund has the capacity to respond rapidly to country needs to accelerate the pace of action and results in countries. Its response will also be able to sustain broad-based and inclusive, country level involvement. Both features fulfill key recommendations arising from the Universal Access country and regional consultations.4 Yet, to fully realize these roles, the Global Fund will need to address four key questions.