As of 1 July 2019, the Technical Review Panel (TRP) has completed its reviews of funding requests for the 2017-2019 allocations and has issued recommendations covering all of the funds available for country allocation ($10.3 billion); all of the matching funds that were subject to TRP review ($313 million); and all of the funds earmarked for multi-country grants ($260 million).
As of the same date, the Global Fund Board has approved 99% of the funds available for country allocation; 99% of the matching funds; and 91% of the funds set aside for multi-country grants.
This information, as well as the information in the balance of this article, was obtained from the Global Fund Secretariat. All of the information is as of 1 July 2019.
A total of 225 country funding requests were submitted in the 2017-2019 cycle; submissions are now complete. The requests yielded 339 grants, 320 of which have been approved by the Board; the other 19 are either awaiting Board approval (4) or are being reviewed by the GAC, the Grant Approvals Committee (15).
Virtually all of the $20.0 million set aside for emergencies –– $19,993,984 to be exact –– has been approved, leaving just $6,916 not yet awarded. The table below shows the amounts approved each year during 2017-2019 and the recipient countries.
|Approved funding||$3.6 million||$4.1 million||$12.3 million|
|Recipient countries||Uganda||PNG, Sudan||Bangladesh, Ecuador, Mozambique, Zimbabwe, Djibouti and Ethiopia|
The focus populations for the emergency funds were frequently refugees and migrants, but also included people affected by natural disasters (e.g. earthquakes, cyclones).
South Sudan should probably be added to the list of recipient countries in Table 1, given that it was identified as a focus population for emergency funding in 2017 and 2018 (associated with the category of refugees); however, we were not able to confirm this before going to press.
Funding for Venezuela
In September 2018, the Global Fund exceptionally donated $5.0 million to support the procurement of antiretrovirals (ARVs) for Venezuela for a period of one year (see GFO article from 3 October 2018). Subsequently, the Fund signed agreements with the Pan American Health Organization (PAHO) for procurement of the ARVs ($4.9 million), and with UNAIDS for civil society monitoring ($100,000).
A master plan covering the procurement and distribution of the ARVs was developed and endorsed by the Government of Venezuela. Contributions for the master plan were also received from other sources.
An informal regional support group was formed to support the implementation and oversight of the master plan. The group includes representatives of PAHO, UNAIDS and the Global Fund, and Venezuelan and international civil society ––Acción Solidaria, Red Venzolana de Gente Positiva (RVG+), Aid for AIDS International, the AIDS Healthcare Foundation (AHF) and ICASO.
The first shipment of ARVs arrived in Venezuela in December 2018. The ARVs were transferred to the central medical warehouse near Caracas, and then, after some delays, to the 37 pharmacies authorized to distribute ARVs.
As GFO previously reported, uptake of the ARVs has been slow due to a number of factors. However, the Global Fund Secretariat says that as of June 2019, about 12,200 people living with HIV were receiving ARVs funded through the Global Fund donation.
The Secretariat has identified several implementation challenges, including the following:
- The political situation in Venezuela is in a constant state of flux;
- Viral load testing is not available;
- There is limited availability of ARVs for alternative regimens for pregnant women and children
- There is limited availability of treatments for opportunistic infections; and
- Civil society organizations face difficulties in carrying out their monitoring responsibilities.
The Secretariat is developing a request for an additional donation; the request will be reviewed by the Strategy Committee at its meeting on 17-18 October, at which time a decision will be made on whether to submit the request to the Board. As there is no existing source of funding for non-eligible countries such as Venezuela, the request would be contingent on identifying a source.
Meanwhile, the Board has decided that Venezuela will be eligible for an allocation for malaria in 2020-2022 (see separate article in this issue).
Unfunded Quality Demand (UQD) and portfolio optimization
For 2017-2019, the Technical Review Panel (TRP) identified $4,339 million worth of initiatives to be placed in the UQD Register. As of 1 July 2019, initiatives valued at $3,059 million remained in the register; the other $1,280 million has been awarded. The $1,280 million figure breaks down as follows:
- Efficiencies and reprogramming ($736 million)
- Portfolio optimization ($504 million)
- Debt2Health ($30 million)
- Private sector ($10 million)
As additional funding becomes available through portfolio optimization, the Global Fund invokes its prioritization framework to identify which high impact interventions should be funded. To date, the GAC has recommended awards totalling $503.9 million in three waves (July 2018, October 2018 and April 2019). About half of this amount has been approved by the Board for integration into existing grants. (The Secretariat approaches the Board for funding approval for each grant when that grant is deemed ready to integrate the additional funds.)
The breakdown of the $503.9 million by component is as follows: malaria 46%, TB 30%, HIV 21% and RSSH 4% (exact percentages have been rounded up).
The funding awarded through portfolio optimization has enabled countries to reduce gaps in service delivery and to increase coverage, as in the following examples:
- TB. Increase TB case finding and treatment.
- Malaria. Cover gaps in indoor residual spraying (IRS) and implement IRS in a timely fashion prior to peak transmission seasons.
- HIV. Accelerate ART scale-up in Central and West Africa (coverage expected to reach 48% in 2020 vs. 43% if no portfolio optimization).
Based on lessons learned from portfolio optimization in 2017-2019, the Secretariat says that it wants to find ways to accelerate the integration of funding awarded through portfolio optimization into grants. This process currently takes 4-6 months.