When the Global Fund Board released its September meeting “decision points” document on funding allocation methods, it was, watchers noted, a part of a piece of a work in progress. But one decision will hold for the next year, and will impact efforts to roll out advances in tuberculosis diagnosis and treatment — the decision to divide money by disease, based on amounts allotted to each disease response in the past.
Prior to the board meeting, the World Health Organization’s Stop TB Department and the Stop TB Partnership urged the board to find another way. Dividing allotments by amounts given to individual disease responses in the past would allot just 16 percent of Global Fund grants for efforts to address a preventable, curable disease that has gone largely unaddressed, their letter said, just at a time when scientific advances are facilitating finding and successfully treating more cases. The letter, which was signed by 67 individual and organization advocates, pointed to two alternatives that would lead to a more appropriate response to the impact of the disease: to base allotments on deaths caused by disease, or by the measure of “disability adjusted life years” — DALYs — of tuberculosis.
Instead, the board decided, “in the absence of a measure of financial need based on disease burden comparable across HIV, TB and Malaria,” to proceed with the plan to divide funds according to past allotment, but promised the method would be temporary, to be replaced within a year with one that would more accurately assess burden and demand. In addition, the board said, the disease division would only be made in apportioning amounts to each country band (or group of countries perceived to have similar degrees of need) and countries could, in turn, divide allotments as they saw fit.
In the wake of the decision, the Stop TB Partnership released a statement thanking the board for the support and commitment it had shown for the fight against tuberculosis during its discussions but adding that “we cannot be very happy with the decision to initially set funding levels for each disease according to historical allocations.”
“It is important to note that this is a one-year temporary measure and that the level of allocation for TB is not set in stone,” the statement said. “We understand too that this measure was proposed to allow the start of a discussion on a model that will make the Global Fund’s allocations more strategic. Discussions remain open on what ‘historical allocation means. If more recent rounds are considered, TB will receive a higher overall allocation.”
In addition, recognizing that a new method would be in place within a year, the statement went on to say advocates must continue to work on determining a method that would lead the Global Fund to support an adequate and appropriate response to tuberculosis.
But, in the meantime, the response to tuberculosis will be damaged, a statement from the Treatment Action Group, one of the signers of the original letter, says.
Colleen Daniels, director of the TB/HIV project at TAG, added that the historic low funding levels anti-tuberculosis efforts have received from the Fund reflect neither the scope of the TB/HIV co-epidemics, nor advancements in technology — including the Xpert diagnostic test, which can detect previously missed tuberculosis cases in HIV infected individuals.
“Policy, program, and practice integration, including HIV and TB diagnosis, treatment and prevention is the best and most effective way to improve outcomes for both HIV and TB in high endemic areas, and these types of programs can not be accelerated if funding for TB is capped at 16 percent over the next year,” the group’s statement says.
The group pledges to continue to oppose the limit, and to work to find another method to determine funding.