1. NEWS: Global Funds Seeks $17-20 Billion from Donors for 2011-2013

GLOBAL FUND OBSERVER (GFO), an independent newsletter about the Global Fund provided by Aidspan to over 8,000 subscribers in 170 countries.

Issue 117: 18 March 2010. (For formatted web, Word and PDF versions of this and other issues, see

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CONTENTS

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1. NEWS: Global Funds Seeks $17-20 Billion from Donors for 2011-2013

The Global Fund says that significant milestones in the fight against AIDS, TB and malaria are within reach if the Fund can raise enough money to maintain and, ideally, accelerate current rates of scaling up expenditure on the three diseases.

2. ANALYSIS: Which Countries Should Give How Much to the Global Fund?

Various scenarios for donor contributions are presented.

3. NEWS: Report Reveals Significant Increase in Impact of Programmes Supported by the Global Fund

According to the Global Fund, programmes supported by the Fund save at least 3,600 lives every day, and there has been a dramatic increase in the volume of services delivered. The Global Fund estimates that the cumulative number of lives saved by the end of 2009 was 4.9 million.

4. NEWS: More than Three Grants in Four ArePerforming Well, Report Says

According to the Global Fund, at the end of 2009, 78% of grants were performing well, 19% demonstrated inadequate performance, and 3% showed “unacceptable” performance.

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1. NEWS: Global Funds Seeks $17-20 Billion from Donors for 2011-2013

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Mother-to-child HIV transmission may be eliminated by 2015; malaria may be eliminated as a public health problem within a decade; TB prevalence could be halved by 2015. However, these health targets can only be achieved if current rates of scaling up expenditure on the three diseases are maintained and, ideally, further accelerated. And that, in turn, requires donors to give the Global Fund between $17 billion and $20 billion during 2011-2013.

This is what the Global Fund announced in a news release issued on 8 March 2010 and in several documents released in preparation for upcoming "replenishment" meetings with donors. The Global Fund says that demand for donor support has more than doubled since the last replenishment in 2007 (which raised $10 billion for the period 2008-2010).

An initial replenishment meeting will be held on 24-25 March 2010 at The Hague, Netherlands. This meeting will provide an opportunity for donors to discuss the Fund's financial needs for 2011-2013 and the results achieved by the Global Fund to date. The meeting will lay the foundation for the pledging conference that will take place at UN Headquarters in New York on 4-5 October 2010.

The Global Fund has provided donors with three possible resource needs scenarios for the period 2011-2013:

Resource Needs Scenario 1, which would cost $13 billion, would allow for the continuation of funding for existing programmes. New programmes could only be funded at a significantly lower level than in recent years.
Resource Needs Scenario 2, which would cost $17 billion, would allow for the continuation of funding for existing programmes, and funding for new programmes at a level that comes close to that of recent years.
Resource Needs Scenario 3, which would cost $20 billion, would allow for the continuation of funding for existing programmes, and for well-performing programmes to be scaled up significantly, allowing in turn for more rapid progress towards achieving the health-related Millennium Development Goals (MDGs).

By presenting the first scenario, at $13 billion, the Global Fund is not forecasting a slackening of demand. Rather, it is attempting to describe the level of demand that could be met with these resources. (If this were any other time, the Global Fund would not present for consideration a scenario which does not provide enough money to meet the current level of demand. However, the Global Fund recognises that the world is experiencing difficult economic circumstances, and that meeting future or even current levels of demand represents a significant challenge.)

The Global Fund has prepared an estimate of the impact of the three resource needs scenarios on services delivered. Details are shown in Table 1, below.

Table 1: Services delivered – Projected numbers through end of 2013

for each of three scenarios

Services delivered / Actual numbers (as of end of 2009) / Projected numbers as of end of 2013
Scenario 1
($13 billion) / Scenario 2
($17 billion) / Scenario 3
($20 billion)
People on ART / 2.5 million / 4.4 million / 5.8 million / 7.5 million
DOTS treatments provided in the last year / 1.4 million / 3.9 million / 5.2 million / 6.8 million
LLINs distributed in the last year / 34 million / 110 million / 147 million / 190 million
Orphans and other vulnerable children supported in the last year / 1.4 million / 2.5 million / 3.4 million / 4.4 million
HIV+ pregnant women receiving PMTCT in the last year / 345,000 / 610,000 / 820,000 / 1.1 million

ART = antiretroviral therapy / DOTS = directly observed treatment, short course (for TB)

LLINs = long-lasting insecticide-treated bed nets

PMTCT = Prevention of Mother-to-Child Transmission of HIV

According to the Global Fund, programmes supported by the Fund are making a significant contribution to attaining the 2015 MDG targets. In this context, 2010 is a decisive year. Money committed now will benefit programs which will have effect on the ground from 2012 to 2015. The Global Fund says that countries are approaching a positive tipping point: If they continue on the current path, the returns will be exponential and the world will reverse the AIDS, TB and malaria epidemics.

“In health, 2010 is a pivotal year to finance the final stretch of the effort to reach the Millennium Development Goals”, said Professor Michel Kazatchkine, Executive Director of the Global Fund. “We have made unprecedented progress but it is fragile. If we lose momentum now there will be a heavy price to pay. A failure to continue the scale-up of investments in health will betray the trust of millions.”

The information for this article is taken from “Resource Scenarios 2011-2013,” available at , and the news release issued by the Global Fund on 8 March 2010, available at .

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2.ANALYSIS: Which Countries Should Give How Much to the Global Fund?

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Donor countries will meet in The Hague, Netherlands, next week for the first of two replenishment meetings to discuss how much they might give to the Global Fund for the three years 2011-2013. (The second meeting will take place in October 2010, in New York.)

Over the years, several formulae have been advanced for calculating what might constitute each country's "fair share" of the Global Fund's financial needs. The first widely-discussed such formula was the Equitable Contributions Framework, advanced in 2002 within the NGO sector and then further developed by Aidspan, publisher of GFO. The basis of that formula was that countries should contribute in proportion to the size of their respective economies.

In preparation for next week's meeting in The Hague, the Global Fund has released a Technical Note in which it outlines four possible formulae, or "contribution scenarios," for obtaining the money that the Fund needs for 2011-2013. (See "Technical Note 1: Illustrative Contribution Tables," at The scenarios are as follows:

Scenario 1 (the "Pro-Rata" scenario): Each country contributes a share of the need that is equal to its share of all contributions given to the Fund during 2007-2009. (Thus, if a country has previously given relatively generously, or otherwise, it is assumed that the country will continue similarly.)
Scenario 2 is based on each country's share of contributions made to the International Development Association (i.e., traditional foreign aid), and is not pursued further here.
Scenario 3 (the "Adjusted GNI" scenario): Each country contributes a share of the need that is equal to its share of global Gross National Income (GNI), adjusted by GNI per capita. (The adjustment is made so that if two countries have the same GNI, but one has a much larger population and hence a lower GNI per capita, the country with the smaller population contributes more, because it has a greater ability to give.) The Adjusted GNI scenario is very similar to the Equitable Contributions Framework; it is assumed that each country gives according to its economic ability, however much or little it has given in the past.
Scenario 4 (the “0.7” scenario): This is a hybrid between Scenarios 1 and 3, in which the contributions of those countrieswhose "Scenario 1 contribution" is less than 0.7 (i.e., 70%) of their "Scenario 3 contribution" are increased to the 0.7 level. The contributions of the other countriesare then reduced to “offset” these additional contributions. (Thus, those countries that have previously been not very generous in relation to their economic ability are assumed to move somewhat nearer to what they are capable of, with the contributions of the more generous countries being reduced correspondingly.)

In an introduction to the Technical Note, the Global Fund says that the scenarios were prepared at the request of donors. However, it also says that the development of the scenarios was a "purely mechanical exercise," done for "illustrative purposes," and not done in an "attempt to assign shares to donors."

The Technical Note contains a series of tables outlining what the contribution of each donor country would be under each of the scenarios. The tables include contributions from private foundations, the private sector and innovative financing schemes.

To supplement the scenarios developed by the Fund, GFO has developed two "bad scenarios" to illustrate the possible thinking of some donors:

Scenario 0 (the "No Increase" scenario): Each country contributes the same dollar amount per year that it has averaged in recent years, even though the need has increased significantly.
Scenario 5 (the "Least Pain" scenario): Each country contributes the least amount of what it should contribute according to Scenarios 1, 3 and 4. (This is because there is a real possibility that many countries will choose whichever scenario is the least painful.)

To complicate matters somewhat, there is no agreement yet on what the total amount is that should be provided to the Global Fund. As discussed in the previous article, the Fund has put forward three resource needs scenarios, ranging from $13 billion to $20 billion. In the two tables below, we show different ways of dividing up contributions to meet the targets for two of the three resource needs scenarios. Table 2 shows contribution levels for Resource Needs Scenario 2 ($17 billion), which would allow for the continuation of funding for existing programmes, and funding for new programmes at a level that comes close to that of recent years. Table 3 shows contribution levels for Resource Needs Scenario 3 ($20 billion), which would allow for the continuation of funding for existing programmes, and also allow well-performing programmes to be scaled up significantly.

(Unfortunately, the Global Fund has elected to use numbers [1, 2 etc.] to describe two different types of scenario – [a] the resource needs scenarios, discussed in the previous article, and [b] the contribution scenarios, discussed in this article. To minimise confusion, each time GFO refers to the resource needs scenarios in this article, it uses the label “resource needs.”)

Findings:

Table 2 (based on Resource Needs Scenario 2) reveals that if all countries follow Scenario 0, the Global Fund will only receive $9.2 billion of the $17 billion three-year need, $7.8 billion less than necessary. And if all countries follow Scenario 5, in which each one chooses the least painful of Scenarios 1, 3 and 4, the Fund will only receive $13.5 billion, $3.5 billion less than is necessary.
Table 3 (based on Resource Needs Scenario 3) reveals that if all countries follow Scenario 0, the Global Fund will only receive $9.2 billion of the $20 billion three-year need, $10.8 billion less than necessary. And if all countries follow Scenario 5, in which each one chooses the least painful of Scenarios 1, 3 and 4, the Fund will only receive $15.9 billion, $4.1 billion less than is necessary.

Notes for both tables:

As previously discussed, data for the shaded columns (i.e., all columns except Scenarios 0 and 5) was developed by the Global Fund. Data for Scenarios 0 and 5 was developed by GFO, based on data in the other scenarios.
For each of Scenarios 1, 3 and 4, the contributions by the European Commission, private foundations, the private sector and innovative finance sources are flat-lined because indicators of capacity to contribute (such as Adjusted GNI) are not relevant to these donors. It is assumed that contributions from the European Commission and private foundations will equal their current shares of total contributions to the Global Fund, and that the contributions from the private sector and innovative finance sources will increase (as a share of total contributions to the Global Fund).
For Scenario 5, which shows the smallest amount from Scenarios 1, 3 and 4, if there is an “n/a” in Scenario 1, it is excluded from the calculations.

Table 2: Amounts that countries might contribute to the Global Fund to meet

the Resource Needs Scenario 2 target of $17 billion, according to five scenarios

Donor / Average Annual Contribution 2007-09,$m. / Total contribution over the three years 2011-2013, $m.
Scenario 0:
No Increase / Scenario 1:
Pro-Rata / Scenario 3:
Adjusted GNI / Scenario 4:
0.7 / Scenario 5:
LeastPain
Australia / 29.0 / 87 / 160 / 291 / 204 / 160
Austria / n/a / n/a / n/a / 138 / 97 / 97
Belgium / 18.6 / 56 / 103 / 176 / 123 / 103
Brazil / 0.1 / 0 / 0 / 70 / 49 / 0
Canada / 127.1 / 381 / 703 / 485 / 657 / 485
China / 2.0 / 6 / 11 / 96 / 67 / 11
Denmark / 29.1 / 87 / 161 / 161 / 150 / 150
European Commission / 143.7 / 431 / 795 / 795 / 795 / 795
Finland / 4.1 / 12 / 22 / 103 / 72 / 22
France / 429.1 / 1,287 / 2,374 / 955 / 2,217 / 955
Germany / 233.4 / 700 / 1,291 / 1,237 / 1,206 / 1,206
Greece / 0.9 / 3 / 5 / 77 / 54 / 5
India / 2.0 / 6 / 11 / 11 / 10 / 10
Ireland / 26.1 / 78 / 144 / 92 / 135 / 92
Italy / 184.5 / 554 / 1,021 / 622 / 954 / 622
Japan / 188.1 / 564 / 1,040 / 1,559 / 1,092 / 1,040
Korea (Rep. of) / 3.3 / 10 / 18 / 188 / 132 / 18
Kuwait / 0.8 / 2 / 4 / 26 / 18 / 4
Luxembourg / 3.4 / 10 / 19 / 29 / 21 / 19
Mexico / n/a / n/a / n/a / 74 / 52 / 52
Netherlands / 93.5 / 281 / 517 / 346 / 483 / 346
New Zealand / n/a / n/a / n/a / 29 / 20 / 20
Norway / 56.7 / 170 / 314 / 302 / 293 / 293
Portugal / 2.8 / 8 / 16 / 38 / 26 / 16
Russia / 68.3 / 205 / 378 / 110 / 353 / 110
Saudi Arabia / 6.0 / 18 / 33 / 49 / 34 / 33
South Africa / 1.1 / 3 / 6 / 14 / 10 / 6
Spain / 151.3 / 454 / 837 / 389 / 782 / 389
Gen.Cat. (Spain) / 2.3 / 7 / 13 / 13 / 13 / 13
Sweden / 84.9 / 255 / 470 / 200 / 439 / 200
Switzerland / 6.2 / 19 / 35 / 272 / 191 / 35
Thailand / 1.0 / 3 / 6 / 5 / 5 / 5
Turkey / n/a / n/a / n/a / 54 / 38 / 38
United Kingdom / 150.5 / 452 / 833 / 1,058 / 778 / 778
United States / 829.7 / 2,489 / 4,589 / 5,757 / 4,287 / 4,287
Other countries / 0.9 / 3 / 5 / 111 / 78 / 5
Sub-total: Countries / 2,880.0 / 8,640 / 15,933 / 15,933 / 15,933 / 12,420
Private Foundations / 100.7 / 302 / 557 / 557 / 557 / 557
Private Sector / 56.2 / 169 / 340 / 340 / 340 / 340
Innovative Financing / 20.3 / 61 / 170 / 170 / 170 / 170
Total / 3,057.2 / 9,172 / 17,000 / 17,000 / 17,000 / 13,487
Total need / n/a / 17,000 / 17,000 / 17,000 / 17,000 / 17,000
Shortfall / n/a / 7,828 / NIL / NIL / NIL / 3,513

Table 3: Amounts that countries might contribute to the Global Fund to meet

the Resource Needs Scenario 3 target of $20 billion, according to five scenarios

Donor / Average Annual Contribution 2007-09,$m. / Total contribution over the three years 2011-2013, $m.
Scenario 0:
No Increase / Scenario 1:
Pro-Rata / Scenario 3:
Adjusted GNI / Scenario 4:
0.7 / Scenario 5:
Least Pain
Australia / 29.0 / 87 / 189 / 342 / 240 / 189
Austria / n/a / n/a / n/a / 162 / 114 / 114
Belgium / 18.6 / 56 / 121 / 207 / 145 / 121
Brazil / 0.1 / 0 / 0 / 82 / 57 / 0
Canada / 127.1 / 381 / 827 / 571 / 773 / 571
China / 2.0 / 6 / 13 / 113 / 79 / 13
Denmark / 29.1 / 87 / 189 / 189 / 177 / 177
European Commission / 143.7 / 431 / 935 / 935 / 935 / 935
Finland / 4.1 / 12 / 26 / 121 / 85 / 26
France / 429.1 / 1,287 / 2,793 / 1,123 / 2,609 / 1,123
Germany / 233.4 / 700 / 1,519 / 1,456 / 1,419 / 1,419
Greece / 0.9 / 3 / 6 / 91 / 64 / 6
India / 2.0 / 6 / 13 / 13 / 12 / 12
Ireland / 26.1 / 78 / 170 / 108 / 159 / 108
Italy / 184.5 / 554 / 1,201 / 731 / 1,122 / 731
Japan / 188.1 / 564 / 1,224 / 1,835 / 1,284 / 1,224
Korea (Rep. of) / 3.3 / 10 / 22 / 222 / 155 / 22
Kuwait / 0.8 / 2 / 5 / 31 / 22 / 5
Luxembourg / 3.4 / 10 / 22 / 35 / 24 / 22
Mexico / n/a / n/a / n/a / 87 / 61 / 61
Netherlands / 93.5 / 281 / 608 / 407 / 568 / 407
New Zealand / n/a / n/a / n/a / 34 / 24 / 24
Norway / 56.7 / 170 / 369 / 356 / 345 / 345
Portugal / 2.8 / 8 / 18 / 44 / 31 / 18
Russia / 68.3 / 205 / 445 / 129 / 415 / 129
Saudi Arabia / 6.0 / 18 / 39 / 57 / 40 / 39
South Africa / 1.1 / 3 / 7 / 16 / 11 / 7
Spain / 151.3 / 454 / 984 / 458 / 920 / 458
Gen.Cat. (Spain) / 2.3 / 7 / 15 / 15 / 15 / 15
Sweden / 84.9 / 255 / 552 / 235 / 516 / 235
Switzerland / 6.2 / 19 / 41 / 320 / 224 / 41
Thailand / 1.0 / 3 / 7 / 6 / 6 / 6
Turkey / n/a / n/a / n/a / 63 / 44 / 44
United Kingdom / 150.5 / 452 / 980 / 1245 / 915 / 915
United States / 829.7 / 2,489 / 5,399 / 6,773 / 5,044 / 5,044
Other countries / 0.9 / 3 / 6 / 131 / 92 / 6
Sub-total: Countries / 2880.0 / 8,640 / 18,745 / 18,745 / 18,745 / 14,612
Private Foundations / 100.7 / 302 / 655 / 655 / 655 / 655
Private Sector / 56.2 / 169 / 400 / 400 / 400 / 400
Innovative Financing / 20.3 / 61 / 200 / 200 / 200 / 200
Total / 3057.2 / 9,172 / 20,000 / 20,000 / 20,000 / 15,867
Total need / n/a / 20,000 / 20,000 / 20,000 / 20,000 / 20,000
Shortfall / n/a / 10,828 / NIL / NIL / NIL / 4,133

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3. NEWS: Report Reveals Significant Increase in Impact of Programmes Supported by the Global Fund

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Every day, programmes supported by the Global Fund save at least 3,600 lives, and there has been a dramatic increase in the volume of services delivered. These are two of the highlights of “The Global Fund 2010: Innovation and Impact,” a report on results achieved which was released by the Global Fund on 8 March 2010. The Global Fund estimates that the cumulative number of lives saved from the Fund's start in 2002 until the end of 2009 was 4.9 million.

Up to 31 December 2009, the Global Fund had approved proposals worth $19.2 billion and had disbursed $10 billion. Programmes financed by the Fund were providing antiretroviral therapy (ART) to 2.5 million people; were providing TB treatment to six million people; and had distributed 104 million insecticide-treated bed nets. Additional information on results for these and other services can be found in Table 4, below.

Table 4: Cumulative results1 of programmes supported by the Global Fund – 2009 vs. 2008

(as reported by the Global Fund)

Service / Cumulative results to end of 2008 / Cumulative results to end of 2009 / Change from end 2008 to end 2009
People currently on ART / 2.0 million / 2.5 million / + 25%
New smear-positive TB cases detected and treated / 4.6 million / 6.0 million / + 30%
Cases of malaria treated / 74 million / 108 million / + 46%
Condoms distributed / 1.2 billion / 1.8 billion / + 50%
Basic care and support services provided to orphans and vulnerable children2 / 3.2 million / 4.5 million / + 41%
Sessions of HIV counselling and testing provided / 62 million / 105 million / + 69%
Nets distributed (ITNs and LLINs) / 70 million / 104 million / + 49%
Indoor residual spraying services provided2 / 14.1 million / 19.0 million / + 35%
HIV+ pregnant women receiving ARV prophylaxis for PMTCT / 445,000 / 790,000 / + 78%
Community outreach prevention services provided (behaviour change communication)2 / 91 million / 138 million / + 52%
Person-episodes of training3 for health or community workers / 8.6 million / 11.3 million / + 31%

ART = antiretroviral therapy / ITNs = Insecticide-treated bed nets

LLINs = long-lasting insecticide-treated bed nets

PMTCT = prevention of mother-to-child transmission

1The results are cumulative from 2002, when the Global Fund was established. Results reported in a year do not necessarily correspond to actual services provided during that year, since grant reporting cycles do not always follow calendar years.

2“Services provided” refers to the number of times individuals were provided with this service. (Some individuals are provided services more than once.)

3“Person-episodes of training” is a cumulative figure that multiplies the number of persons attending a training programme by the number of training programmes.

(As indicated above, these results are attributable to programmes supported by the Global Fund. This does not mean that the Global Fund alone can take credit for this; many of these programmes were also supported by national governments and other donors.)

The Global Fund says that every dollar it receives goes to fund in-country programmes because the Fund’s operating expenses are almost entirely covered by interest earned on donations. The Fund says that the coming years will see even better results because half of the total disbursements to date by the Global Fund were made in 2008 and 2009 alone. In addition, much of the $5.4 billion of financing approved in the last two rounds of proposals (8 and 9) will reach countries in 2010 and 2011, and will continue to significantly boost health outcomes.

According to the Global Fund, its investments have helped accelerate progress towards a number of Millennium Development Goals (MDGs). Programmes supported by the Global Fund make a direct contribution to MDG 6 (“Combat HIV/AIDS and malaria and other diseases”). In addition, major contributions have also been made to MDG 4 (on child mortality) and MDG 5 (on maternal mortality) by reducing the largest causes of mortality among women and children. The results report points out that continued, substantial increases in long-term financial commitments by donors will be needed to consolidate the gains and to reach the MDGs by the target date of 2015.