At the beginning of this century, developing countries – particularly in Africa – experienced rapidly rising illness and death from AIDS, Tuberculosis, and Malaria. The three diseases caused massive suffering and economic damage. Treatment and interventions to control the spread of the diseases were available in rich countries, but experts thought it too expensive and too complex to make life-saving interventions available in the poorest countries.

At the urging of the Secretary-General of the United Nations, Kofi Annan, a new international financing mechanism was created by world leaders. Since its creation in 2001, the Global Fund to Fight AIDS, Tuberculosis, and Malaria has saved millions of lives and disbursed over $35 billion in funding. Countries as different as Benin, Bolivia, Bulgaria, Central African Republic, China, Russia, or Rwanda used Global Fund financing to contain the diseases. Death rates in many African countries have fallen by more than half, and the international community is now rallying around calls to end the diseases altogether.

The rapid and dramatic progress in the fight against the three diseases was unexpected. Instead many observers predicted that the Global Fund would fail. Success can be explained by eight “design principles” that equip the Global Fund to meet the operational challenges it faces in financing programs to control, prevent, and treat the three diseases in a diverse set of countries.

The Global Fund invites recipient countries to design and implement their own programs. Proposals are vetted rigorously by an independent technical panel that considers only the technical quality of the proposed program instead of the political situation in a country. Since halting the spread of the diseases requires action from all parts of society, proposals to the Global Fund must be developed and supported by multi-stakeholder mechanisms that comprise representatives of governments, civil society, people living with the diseases, and business. Thanks to the combination of country ownership and independent technical program appraisal, the Global Fund has generated many high-quality requests for funding, including from countries experiencing conflicts or weak governments. Only the best proposals are funded. Up to 3 out 5 requests have been turned down.

The Global Fund provides funds to governments, local or international civil society organizations, businesses, or international organization. It can therefore support different models for delivering treatment and control measures against the three diseases, which in turn spurs innovation. As a result, the health sector has quickly improved its capacity to tackle all three diseases. Since all Global Fund program documents are publicly available, innovations from one country travels quickly to other countries – a process that is aided by the Global Fund’s “technical partners”, including the World Health Organization or the AIDS Program of the United Nations.

Throughout, the Global Fund has maintained a lean organization to reduce bureaucracy and transaction costs. Despite its light-touch business model, the Fund has largely succeeded in avoiding and fighting corruption or misuse of its own funds. Rigorous third-party program evaluations and audits keep everyone honest.

The success of the Global Fund shows that the health sector needed a new financing institution to mobilize greater volumes of funding, but also to support innovation in the fight against the three diseases. The recently adopted Sustainable Development Goals (SDGs) can only be achieved if a similar acceleration of progress can be achieved in the fight to improve education, ensure access to basic infrastructure, decarbonize energy systems, and so forth. The experience of the Global Fund holds important lessons and suggests that well-designed international financing mechanisms can help mobilize and organize an international response to the complex challenges of meeting the SDGs.

Guido Schmidt-Traub
Sustainable Development Solutions Network, Paris, France

Publication

Global Fund lessons for Sustainable Development Goals.
Sachs JD, Schmidt-Traub G
Science. 2017 Apr 7

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