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Sustainability, Transition & Co-Financing

As low- and middle-income countries grow economically, they can increase spending on health, progressively moving away from donor financing toward domestically funded health systems. This is a welcome trend, but countries must be supported to do so in order to achieve lasting impact in the fight against HIV, tuberculosis and malaria.

The Global Fund works closely with countries to help them achieve long-term sustainability of health programs, so they can maintain progress and continue to expand services after Global Fund support ends. Ultimately, ending the epidemics will only be achieved with sustainable health systems that are fully funded by countries through their own resources.

The Global Fund partnership takes a holistic approach to sustainability, both at the programmatic and financial level. Working with partners, we engage with all countries, regardless of their income level and disease burden, to support well-planned and successful transitions. Experience shows that planning a transition from Global Fund support takes time and resources.

Key pillars of our work on sustainability, transition and co-financing:

  • Support countries to develop robust national health strategies, health financing strategies and national disease strategic plans
  • Encourage additional domestic investments; require minimum 15% co-financing for every country allocation
  • Accelerate efforts to prepare for transition, particularly for upper-middle-income and lower-burden, middle-income countries
  • Strengthen focus on key populations and structural barriers to health
  • Work with partners to advocate for programmatic and financial changes
  • Strengthen alignment between Global Fund grants and country systems
  • Support countries to identify efficiencies and optimize disease responses

Stimulating domestic financing

Encouraging and stimulating domestic investments in health is an essential component of the Global Fund’s strategy. The US$14 billion raised for the Sixth Replenishment seeks to spur domestic investment of US$46 billion through co-financing requirements, and technical assistance on health financing. Our Sustainability, Transition and Co-Financing Policy aims to support countries as they move toward full domestic funding of their systems for health, including their HIV, TB and malaria programs. In our 2017-2022 strategy, the Global Fund commits to work with all implementing countries to increase domestic resource mobilization for health, with a particular emphasis on investing in programs that support key and vulnerable populations.

Transition planning

The Global Fund works with countries to plan for transition. One way to do this is by conducting transition readiness assessments with the government and partners. Such assessments look into several factors including the country’s epidemiological context, domestic funding and budget priorities, the policy and legal environment, and support for human rights, gender equality, and key and vulnerable populations. To strengthen planning and better manage transitions, the Global Fund provides transition funding for up to three years to disease programs that become ineligible for regular Global Fund grants.

Key populations and human rights

The Global Fund is an important investor in programs that serve key populations such as men who have sex with men, sex workers or people who inject drugs. The Global Fund is engaged with countries and partners, particularly in middle-income and upper-middle-income countries, to address human rights and gender-related barriers so that no one is left behind when our support ends. Our co-financing policy encourages governments to focus investments on key and vulnerable populations.

Health financing and innovative finance

To leverage additional domestic financing and continue expanding prevention, treatment and care for people affected by the diseases, the Global Fund explores the potential for innovative and alternative financing mechanisms with countries and development partners. We also support efforts by countries to implement financing strategies aimed at expanding domestic funding to guarantee sustainable health systems and reduce dependence on donors.

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Global health security

Strong and sustainable systems for health are essential for ending the epidemics and moving toward universal health coverage. They are also the sentinels that guard against regional or global outbreaks that threaten our global health security, including the growing menace of antimicrobial resistance. The Global Fund invests in areas that are critical for global health security, including community health workers, laboratories, data management, and supply chains. Community health workers are the front line of a health system, connecting communities to the national disease surveillance and response system.

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Malaria heroes of the Mekong

In the Greater Mekong, the Global Fund’s Regional Artemisinin-Resistance Initiative supports more than 20,000 malaria volunteers across five countries. These people are typically members of the community they serve – a neighbor or a coworker – who have been equipped with knowledge and resources to promote prevention activities, as well as test for and treat cases. Their proximity to risk hot spots means more malaria cases found and treated, and more lives saved.

Learn more about building resilient and sustainable systems for health.

Resilient Systems for Health

Published 25 September 2020

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