Global Fund board decides model, but it is still a work in progress

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When the board of the Global Fund to Fight AIDS, Tuberculosis and Malaria met last week, it settled, for at least the next year, how decisions to fund country responses to the three diseases will be guided. The decisions made, however are just one part of what disease response advocates are saying could make the most of the decade-old charity’s original mission, but also could threaten what has so far made the Global Fund’s response unique. How the new funding model decided in Geneva September 13 – 14 will look in the countries with the most at stake, will take form in November.

Among decisions at the meeting last week, the board agreed to: establish groups of countries referred to as “bands” that would be based on disease burden and ability to pay, determine portions available to those bands, distribute funding, in part by disease burden, and develop principles that would determine the delineation of and allotments to those bands in ways that would be both responsive to requests, and encourage ambitious planning.

It is a model, that while leaving questions, offers the potential for the Global Fund to live up to its promise, advocates said.

“The one that’s moving forward is the best of both worlds,” amFAR Deputy Director Owen Ryan told Science Speaks. He added, “I think there’s much more left to be done.”

The Global Fund’s plans to reorganize, announced in the wake of funding woes in 2011 was intended to make disease responses both more sustainable and adaptable to advances in medicine and technology. The plan however also raised questions if changing a model that had been driven by demand would make the Fund more responsive to donors’ concerns than to the needs the Fund was formed to meet.

“Countries weren’t being told, ‘this is your cut-off, you can’t think beyond this,'” Health GAP International Policy Director Asia Russell told Science Speaks. The result: through their requests, countries made real needs known. A model that would allocate funding amounts according to country income and disease burden, brings the possibility of losing that knowledge, Russell said. A model that set limits on how much countries could ask for could also cost countries with vast economic inequities or marginalized populations bearing the brunt of their epidemics the chance to address those needs effectively, she said.

“From the conversation starter,” she said, “comes the looming threat of a conversation stopper.”

The result, she said: “We end up not knowing what the true needs look like.”

The new model will only work if it is based on evidence, she said. It offers, she says, both an opportunity, and a risk that opportunity will be discarded.

The board’s decisions can be downloaded here.

The next move comes in November, and Science Speaks is interested in your thoughts on what will, or should, happen then.



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