Sustainability, Transition and Co-Financing

Working with countries to sustain hard-won gains and progress made against the three diseases is fundamental to the Global Fund’s approach. Strengthening sustainability requires both continued investments in reducing the burden of disease, while at the same time supporting countries to assume greater financing and responsibility for ending these diseases as epidemics as they move toward greater self-reliance. 

Ultimately, this will only be achieved with sustainable health systems that are fully funded by countries through their own resources. 

Guided by the Sustainability, Transition and Co-Financing Policy [ download in English ], which was revised in 2024, the Global Fund partnership takes a holistic approach to sustainability. We do this by supporting the scale-up of new technologies and service delivery, catalyzing better and more efficient use of domestic financing, increasing our alignment with and implementation through national systems, and supporting strong national sustainability and transition planning to gradually support countries to assume full leadership of the national responses. 

The Global Fund defines sustainability as the ability of a health program or country to both maintain and scale up service coverage to a level in line with the epidemiological context. This provides for ongoing control of a public health problem and supports efforts for elimination of the three diseases, even after external funding by the Global Fund and other major external donors comes to an end. 

In practice, there are many factors that influence sustainability, which differ on a country-by-country basis and require country-tailored responses. Efforts to maintain sustainability gains and address challenges should consider financial, programmatic and political realities countries face. The Global Fund encourages and supports all countries to ensure sustainability is embedded into their national responses and grant design. 

The Global Fund is fully committed to the premise that countries must be self-reliant in financing and managing HIV, TB and malaria programs over time. Working hand in hand with countries, the Global Fund prioritizes planned, predictable transitions.

The Global Fund defines transition as the mechanism by which a country, or a country component, moves towards fully funding and implementing its HIV, TB and malaria programs independent of Global Fund support. A successful transition is one in which previous gains against HIV, TB and malaria are maintained and scaled up, as appropriate, even after external support has come to an end.

The Global Fund’s approach to transition has evolved over time, alongside its funding model, policies, and its approach to eligibility, sustainability, and transition. Since the founding of the Global Fund, 52 disease components (HIV, TB and malaria) across 38 countries have transitioned. In the grant cycle 7 (GC7), 12 disease components from eight countries are transitioning, the largest cohort in a single grant cycle since the approval of the STC policy in 2016. While the majority of the transitions have been precipitated by changes in eligibility, there have also been examples of voluntary transitions. Transitioned disease components may also be included in multicountry or regional grants, in line with the Global Fund’s eligibility policy.

Disease components fully transition from Global Fund support when they are no longer eligible for funding, voluntarily transition, and/or have received their final allocation. Preparations for transition may also be affected by changes in the size of Global Fund allocations and/or the investments of other funding partners, which may require countries to progressively assume key parts of the national response well before they stop receiving Global Fund financing. For this reason, the Global Fund encourages all countries to plan well in advance of expected transitions.

Lessons learned suggest that successful transitions take time and require resources. Early and proactive planning is a key part of transition preparedness. The Global Fund supports countries to incorporate transition considerations into funding request development, grant design, grant implementation, national planning processes – including, where relevant, transition planning and assessments – and the overall management of national responses.

In grant cycle 8 (GC8), the Global Fund has defined transition timelines for a subset of the portfolio for GC8 and GC9, in line with the revised STC policy. The Global Fund has set these transition timelines to encourage advanced transition planning, avoid abrupt transitions and strengthen predictability and transparency in Global Fund financing. Given differences in the epidemiological situation across HIV, TB and malaria, timelines have been set by country component, and, in some cases, countries may have components transitioning on different timelines.

Since GC8 and GC9 transition timelines for country allocations have been defined for a large number of components, projecting transitions based on economic data is no longer appropriate and the Global Fund no longer publishes transition projections based on potential changes in income classifications. The full list of defined transition timelines [ download in English ] for the GC8 and GC9 allocation cycles is publicly available to increase transparency for all stakeholders supporting countries and national HIV, TB and malaria responses.