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Sustainability, Transition & Co-Financing

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The Global Fund / Jonas Gratzer

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 each grant
  • 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

Increasing domestic financing for health is essential to end the diseases as epidemics and is a pathway to sustainability. National governments have significantly increased investment of domestic resources in health, including funding the fight against AIDS, TB and malaria. Global Fund co-financing requirements have played a catalytic role in supporting a 35% increase in co-financing during the implementation period of the 2014-2016 allocation. Countries have further committed an additional US$7.9 billion to their health programs for the implementation period of the 2017-2019 allocation, representing a 42% increase compared to the previous cycle. The Global Fund’s Investment Case projects that domestic funding for programs to fight HIV, TB and malaria over the period 2021-2023 will grow to US$46 billion, an increase of 48% over the current cycle. These figures are based on co-financing commitments made in the current cycle and broader political commitments to health system development.

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.

The Global Fund / John Rae

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.

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.

Learn more

The Global Fund / Nichole Sobecki

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.

Published 08 April 2019

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