In-depth: A deadly funding crisis

HIV/AIDS: Following the Fund

Photo: Siegfried Modola/IRIN

Kofi Annan announced the creation of the Global Fund in 2001

JOHANNESBURG, 1 December 2011 (PlusNews) - With a shortfall as high as US$6 billion and forced to cancel its latest round of funding, the Global Fund to Fight AIDS, tuberculosis (TB) and Malaria is at a crossroads, and a far cry from where it started.

In this timeline, IRIN/PlusNews looks back at the international funding mechanism that revolutionised the fight against HIV and has put 2.8 million people on HIV treatment.

July 2000 - The idea of a fund for HIV and other communicable diseases is proposed at the G8 summit in Japan. Support from United Nations Secretary General Kofi Annan and the World Health Organization (WHO) follow a year later.

June 2001 - Annan announces the fund's creation and welcomes pledges from donor nations and the private sector at the close of the UN Special Session on HIV/AIDS. In August, a transitional working group of country and organizational representatives sets out the fund's principles, purpose and scope, and decides to include TB and malaria.

January 2002 - The Global Fund to Fight AIDS, TB and Malaria is formally established. By March, the Fund receives about 320 proposals for projects in up to 100 countries.

April 2002 - Having received more than $2 billion in pledges, the Fund awards almost $380 million to 40 programmes in almost as many countries. Some donor countries pay more than they originally pledge. The board also fast-tracks approval of about $240 million for further programmes.

The Fund elects its first executive director, Sir Richard Feachem, former dean of the London School of Hygiene and Tropical Medicine and World Bank Director for Health, Nutrition and Population.

2005 - The Fund moves away from an ad hoc system of donations to soliciting contributions in regular replenishments to allow for more accurate forecasting. In August, the Fund suspends grant money to Uganda after discovering that $280,000 was misspent by individuals in the Ministry of Health's special Programme Management Unit.

Funding resumes after the Uganda government launches a formal inquiry into the matter, but the country loses out on several grant renewals due to the scandal. Funding is also partially suspended to South Africa and Senegal due to poor performance.

The Fund begins to develop a risk assessment model but it is never implemented due to its inability to accurately programme risks such as poor implementation and procurement capacities.

2006 - Funding to Chad is suspended after misuse is discovered. The suspension is lifted a year later after a series of investigations, and commitments from stakeholders to put better systems in place.

April 2007 - Dr Michel Kazatchkine, former vice-chair of the Fund's board, replaces Feachem as the Fund's executive director. Kazatchkine began working in HIV in 1983 after diagnosing a young French couple and later established an HIV clinic in Paris.

2009 - The Fund unearths more financial mismanagement in Kenya, Mauritania, Philippines and Zimbabwe.

2010 - The Fund has now distributed almost $11 billion to fight HIV, TB and Malaria, but is rocked when its Office of the Inspector General discovers fraud in Mali, Mauritania and Zambia. Negative media reports are credited with fuelling panic among donors, including Sweden and Germany, and funding to the delinquent countries is suspended until a high-level panel review of the Fund's financial risk management is completed.

October 2011 - The Fund postpones Round 11 of grant applications for the second time due to lower than expected contributions after non-payment by donor countries including Spain, Italy and the Netherlands, and lower interest rate returns on the Fund's World Bank account.

Countries are told to continue working on their applications, and that successful round 11 applicants will be able to access money in late 2013. The Fund prepares to supply up to 10 countries, largely in Africa, with emergency stopgap funding.

The high-level panel's findings call for minimizing the Fund's financial risk, prompting Sweden to return to the table.

November 2011 - The Global Fund is changing in response to the high-level panel's findings and its board is forced to cancel the embattled Round 11. It announces the establishment of a transitional funding mechanism to provide primarily for continued treatment.

"Hiding behind the banner of the financial crises, the donor countries have clearly decided that if budgetary cuts are to be made, the Global Fund can be among the first to go," Stephen Lewis, former UN Special Envoy for AIDS in Africa, now head of the NGO, AIDS-free World, says in a speech at the Yale School of Public Health. "It's not just the fact that people will die; it's the fact that those people who have made the decision know that people will die."

HIV activists react somewhat belatedly and formulate plans to highlight the urgent need to ensure the Fund's continuation at the upcoming International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), in Ethiopia.

llg/he

A deadly funding crisis
December 2011

Straight Talks

HIV/AIDS: Straight talk with Global Fund director Michel Kazatchkine

HIV/AIDS: Straight Talk with Eric Goosby, head of PEPFAR

HIV/AIDS: Straight Talk with Stephen Lewis

HEALTH: Straight talk with Stop TB Director Mario Raviglione