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In what local activists are hailing as a “very important step in ensuring the sustainability of HIV services in Macedonia," the newly elected government has ordered the Ministry of Health to budget a considerable amount of money to provide antiretrovirals for people living with HIV as well as prevention services to key affected populations such as men who have sex with men, persons who inject drugs, and sex workers.


In this second instalment in our series on absorption issues, we look at problems that occur at country level. Lapsed funding is usually the result of delays in disbursements. Tardy disbursements, in turn, can be caused by human resource capacity problems, procurement difficulties, gaps in data collection and analysis, and shoddy construction of facilities that are used for Global Fund-related activities. 


Safeguards implemented by the Secretariat have effectively reduced financial and fiduciary risks to Global Fund grants to Cambodia, concludes an audit by the Office of the Inspector General. Unfortunately challenges in operationalizing the safeguards have led to prolonged delays in implementing some key activities in Cambodia’s malaria program. Finding the right balance between mitigating fiduciary risks and program risks is a challenge.


The path towards sustainability of HIV and TB services for key affected populations in Bulgaria is unclear. The Global Fund is on its way out, and the government has so far not budgeted for services at the same level as what the Fund was supporting. NGO advocacy remains weak, and many activists see little recognition by government and local authorities of the NGO role in the response to HIV and TB.


Burkina Faso is being allowed to transfer € 2.6 million from its TB/HIV and RSSH grants, where the funds were projected to remain unused, to its malaria grant, where there was a gap in funding. The transfer allows Burkina Faso to avoid having funds lapse.


Although the U.K.’s Department for International Development increased its contribution to the Global Fund at the Fifth Replenishment Conference in 2016, DFID has significantly cut its bilateral programs focusing on HIV. Funding for HIV-specific programs declined from a peak of £221 million in 2009 to £23 million in 2015.


The Global Fund has posted its Register of Unfunded Quality Demand online. There are two databases, one for 2014-2016 and one for 2017-2019. The Fund has indicated that in 2014-2016 almost $1 billion in interventions from the register were funded.


The “Results Report 2017” provides results for the period ending December 2016. In passing, the report revealed that the Global Fund is embarking on an ambitious fundraising drive to raise $500 million before the next replenishment conference.


Two new publications on civil society and communities have been published by ICASO and the Global Forum on MSM & HIV.