Global Fund Board Takes Unprecedented Set of Decisions to Strengthen Sustainability and Gears Up for Eighth Replenishment
26 November 2024
LILONGWE, MALAWI – The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) held its 52nd meeting last week in Lilongwe, Malawi. The country was selected to host the event in recognition of its remarkable progress against HIV, tuberculosis (TB) and malaria over recent decades, which contributed to the improvement of life expectancy in the country from 44.7 years in 2000 to 62.5 years in 2021.
The meeting was opened by Dr. Lazarus Chakwera, President of Malawi, who commended the Global Fund for its game-changing contribution to the fight against HIV, TB and malaria in the country, noting a 39% decline in malaria cases and a 25% reduction in malaria deaths, and strong progress against HIV and AIDS. Between 2004 and 2024, over 10 million people accessed HIV testing, and nearly 1 million received lifesaving antiretroviral therapy. President Chakwera highlighted how the Global Fund has consistently stood by Malawi's side, supporting the country through various challenges, from COVID-19 and floods to mpox.
Significant Policy Changes to Drive Sustainable Impact
Throughout the three-day meeting, the Board recognized that the Global Fund’s mission faces numerous challenges, including extraordinary fiscal pressures on countries, restrictive civic spaces, global conflicts, and climate change. To protect the gains achieved against HIV, TB and malaria while driving sustainable progress towards ending these diseases, the Board adopted an unprecedented, wide-ranging set of policy changes.
These changes, which prepare for the next three-year grant cycle starting in 2026 (Grant Cycle 8), were effected through revisions to the four policies most influential in guiding how the Global Fund’s resources are allocated and used: the Eligibility Policy; the Allocation Methodology; the Sustainability, Transition and Co-Financing Policy; and Catalytic Investments. The revisions were approved unanimously by the Board.
Changes to the Eligibility Policy and Allocation Methodology will shift funding towards lower-income countries and increase the proportion of funding for TB and malaria. Changes to the Sustainability, Transition and Co-Financing policy will strengthen the rigor and specificity of co-financing requirements and enable better preparations for transition, in order to support sustainable progress in the fight against the three diseases.
To facilitate the implementation of this set of revisions and contribute to a more streamlined, impactful, and sustainable global health response, the Board encouraged the Global Fund to continue supporting countries’ efforts to strengthen public financial management (PFM). The objective is to enable the delivery of credible, priority-oriented health budgets, integrated disease programs, efficient flow of funds, effective budget execution and strengthened accountability.
Catalytic Investment priorities for Grant Cycle 8 will focus on components of the Global Fund’s Strategy that are critically needed to accelerate progress but are not fully addressed through Country Allocations. This includes human rights, gender equity, NextGen Market Shaping to enable accelerated access to new innovations, and countering the impact of climate change on the health of the poorest and most vulnerable communities. The Catalytic Investment priorities for Grant Cycle 8 are also designed to leverage private sector contributions.
“These critical decisions set the stage for the Eighth Replenishment and shape our approach for the next grant cycle,” said Lady Roslyn Morauta, Chair of the Global Fund Board. “By sharpening our focus on countries with the greatest needs, enhancing country ownership and fostering sustainable financing, we are reinforcing our commitment to the millions of people whose lives depend on our work.”
“The sustainability levers we are activating are essential to maximizing impact, protecting hard-won gains and ensuring the long-term success of the Global Fund’s mission for the communities we serve,” said Peter Sands, Executive Director of the Global Fund.
In addition, the Board approved the Global Fund Secretariat operating expenses (OPEX) budget for 2025, set at US$346 million, and approved adjustments to the risk appetite statements, addressing in-country supply chain risks and grant-related fraud and fiduciary risks.
Sustaining Efforts Against Impacts of Climate Crisis and Human Rights Erosion
In broad discussions, Board members constantly emphasized the critical importance of sustaining investments in health and community systems to underpin the fight against HIV, TB and malaria, bolster pandemic preparedness and accelerate the pathway towards Universal Health Coverage (UHC).
Alert to the simultaneous discussions at COP29, they reiterated their concern over the growing health impacts of the climate crisis, and called on the Global Fund to continue supporting countries in building climate-resilient systems for health and responding to climate-related disasters. A session in conversation with Malawi's Minister of Health, Khumbize Chiponda, highlighted the challenges confronting Malawi due to the increasing number of climate-related events, such as droughts and cyclones, which are disrupting the provision of health services to the most vulnerable and fueling vector-borne diseases, such as malaria and cholera.
In another session, the Board reaffirmed its commitment to addressing human rights- and gender-related barriers that impede access to health care, including stigma and discrimination.
“The Global Fund partnership must take decisive action to safeguard civic space and resist the global erosion of rights, which could have devastating consequences for public health if ignored,” said Bience Gawanas, Vice-Chair of the Board. “Communities are at the heart of everything we do. Every Global Fund program must continue to prioritize the needs of the most vulnerable – girls, women and other marginalized groups.”
Mobilizing for a Successful Eighth Replenishment
With just five years remaining to achieve the Sustainable Development Goals, the Board called upon the entire partnership to rally behind the critical goal of securing the best possible outcome for the Eighth Replenishment next year.
“For both HIV and TB, we have strong momentum, with the HIV target for 2030 within sight, and record numbers of people being successfully treated for TB; for malaria, by contrast, we are at risk of stalling or even reversing progress and need to act more boldly to break the cycle of malaria transmission,” said Sands. “Across all three diseases, innovative, game-changing tools create new opportunities and reasons for hope. The success of the Eighth Replenishment will determine the Global Fund’s ability to accelerate equitable access to such innovations, and will drive the pace of progress toward ending the three diseases as epidemics. In an increasingly fragmented world, the Global Fund partnership must stand united as a beacon of global solidarity and humanity.”
“Partner countries, governments, civil society and communities are looking to the donors with trust and hope that the partnership will take our duty forward and ensure a successful Replenishment,” concluded Morauta.