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Thre e years after its creation, the Global Fund to Fight AIDS, Tuberculosis and Malaria says it is proving to be a key engine behind the scale-up of the fight against the three pandemics worldwide. The fund is a global public-private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV and AIDS, tuberculosis and malaria.

It works in close collaboration with other bilateral and multilateral organisations to supplement existing efforts dealing with the three diseases.

Despite an average age of only 15 months, Global Fund-financed programmes support 220 000 people on AIDS treatment and have provided treatment for 600 000 patients with TB and 1,1-million patients with malaria.

These results are ahead of mid-year targets for 2005.

The Global Fund currently contributes a fifth of all external resources worldwide to fight HIV and AIDS, two-thirds of all external resources against TB and well over half against malaria.

An analysis of the Global Fund's grant portfolio shows that of the 74 grants that have reached 18 months of age, 80 percent have met or exceeded targets and that taken as a whole, the 74 grants have exceed all targets except those for the distribution of insecticide-treated bed nets (ITNs).

The Fund grants enable countries to scale up their fight against the three diseases in a sustainable way by strengthening health systems and paying for drugs, diagnostics, mosquito nets and other commodities.

It has allocated $3,1-billion for the first two years of 316 programmes in 127 countries with a total five-year value of $8,1-billion.

Of the $3,1-billion committed over the first two years, 56% goes to fight HIV and AIDS, while 13% goes to fight TB and 31% to malaria.

Sixty per cent is spent in sub-Saharan Africa.

A total of $1,4-billion has been disbursed to programmes so far.

Expenditure targets for Global Fund grants are 49% for drugs and related supplies, 20% for human resources, 13% for physical infrastructure, six per cent for monitoring and evaluation, seven per cent for administration and five per cent for other purposes.

A separate analysis of grants to "fragile" states (defined as states that "cannot or will not deliver core functions to the majority of their people, including the poor") shows that grants to such states perform only marginally less well than grants to other low and middle-income countries.

"It is extremely gratifying to see that our grant portfolio is doing well - even better than expected," said Dr Carol Jacobs, the Chair of the Global Fund's Board.

"It indicates that the Global Fund's financing structure, which lets countries design and implement their own programs and which rewards good performance, works even in countries that traditionally are not able to use external financing well."

"We are financing programs to most of the world's poorest countries, and the health sector traditionally receives the smallest part of these countries' budgets," said Professor Richard Feachem, the Executive Director or the Global Fund.

"Starved of educated personnel and infrastructure, these countries are rarely well prepared to turn large new resources into results quickly.

"The fact that these programmes have achieved substantial results after such a short time is a tribute to the tremendous efforts made by thousands of health workers operating under extremely difficult conditions," said Feachem.

While the latest progress report points to a steady improvement in results and a persistent trend of a high-performing grant portfolio, it stresses the Fund needs to sharply increase the rate of programme acceleration in the next four years if it is to achieve its five-year targets.

Annual targets have been set - based on grant agreements - for the scaling up of Global Fund-supported grant activities in order to reach 1,6-million people with ARV treatment for AIDS and 3,5-million people with TB treatment, and to distribute or re-treat 108-million ITNs to protect families from malaria over the five-year lifespan of all grants approved to date.

If these targets are reached, this will increase global coverage two or more times from current levels.

While most programmes financed by the Global Fund have a five-year time frame, the Global Fund initially commits funds only for the first two years.

Continued funding depends on performance towards agreed-upon targets, measured when the grants have been in operation for 18 months.

Grants are graded according to their performance, and decisions on continued funding are taken based on the performance grading combined with an assessment of contextual information.

So far, 70 of the 74 grants that have gone through this process have received commitments of continued funding for years three through five ("Phase 2"); one has been terminated and three are still under consideration by the Global Fund Board.

Nineteen of the 74 grants assessed for Phase 2 funding were from fragile states.

While the analysis cautions that this sample size is too small to draw strong conclusions, it indicates that the incentives of performance-based funding and innovative collaborations between public and private sectors are factors that have led to successful performance of grants in states where such performance is unexpected.

The study of grants from fragile states will continue as the number of grants that undergo Phase 2 review increases.

One-third of the Global Fund's total portfolio of $3,7-billion has been committed to states determined to be fragile. - BuaNews

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