U.S. Secretary of State John Kerry delivers remarks during the partnership symposium of the fourth replenishment conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2013 in Washington, D.C. Earlier this year, the U.S. government, which is the fund’s biggest donor, proposed to cut its funding by 18 percent.

The past five years have not been kind to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Donations to the public-private partnership decreased in 2011 and 2012 because of the global financial crisis. Reports of grants mismanagement, meanwhile, led to a cancellation of new funding rounds until 2014. And then, earlier this year, the U.S. government — the Global Fund’s largest donor — proposed to cut funding 18 percent from $1.3 billion in fiscal year 2015 to $1.1 billion in fiscal 2016.

But the Global Fund is optimistic of brighter prospects in the coming years.

Ernest Waititu, a media specialist at the public-private partnership, shared with Devex that it is not anticipating any decreases in its budget or overall investments during the 2017-2019 period. In its previous replenishment period for 2014-2016, $12 billion in initial pledges were made by 25 countries, as well as the European Commission, private foundations, corporations and faith-based organizations. For the next replenishment round, the Global Fund has not seen any indication that donors will cut their pledges — in fact, the PPP expects to see increases in financial support despite ongoing global economic challenges.

The Global Fund seeks contributions and support from many and diverse partners with the goal of galvanizing sufficient resources to end the three diseases as epidemics, while simultaneously building resilient health systems.

This month, the Global Fund will begin a yearlong process to set its 2017-2021 strategy. As part of this process, it will look at how to continue its mandate to support fragile states, key populations and harm-reduction services, and to support domestic financing for health and country transitions away from Global Fund financing.

The new strategy is being developed through a consultative process. Waititu told Devex that it would be premature for the Global Fund to comment on the specifics of a document that partners are still contributing to.

“The circumstances of global health are constantly changing, and the Global Fund is evolving in a way that encourages countries to integrate their approach to health,” he explained. “The board is already working on an updated strategy, to begin in 2017.”

Country confusion

At the same time as wrangling with these financial transitions, hundreds of miles away from the Global Fund’s Geneva headquarters the principal recipients of its grants are coming to terms with a new funding model.

When the Global Fund first broached a new funding model, it agreed to some basic principles, which included having a commitment to country ownership, demand-driven funding, investing in interventions that showed impact, ensuring human rights and gender were prioritized, and making certain that effective risk management was put in place.

“The scope of investment remains global, but it is increasingly focused on communities where the greatest impact can be achieved,” Waititu noted.

But implementing partners themselves aren’t entirely certain about the processes under this new model.

“For Nepal, frankly speaking, we haven’t yet submitted new concept notes for the new funding model,” Tara Chettry, chief of party at the Global Fund program at Save the Children, told Devex. “We’re still trying to understand what it is like.”

In the old system, Chettry explained, the country had to prepare a proposal for submission. Thereafter, the technical review panel would confirm that the nongovernmental organization had done everything necessary to receive the funds requested. Now, the country team — headed by the fund portfolio manager — will have a much more significant involvement.

The new model allows greater flexibility, with a technical review panel holding consultations and providing feedback so that the concept notes have a greater chance of being approved.

“Our fund portfolio manager is heavily engaged with us. He’s also engaged in looking into the targets beyond 2016 to 2019, because that’s the cycle we’re looking at now,” Chettry said.

Eligibility criteria

But for countries like Montenegro, the story is dismal.

“We are not eligible anymore to be a single applicant, unfortunately, because the majority of the services that are being done by the NGO sector will not be financed,” Icana Labovic, program manager at the U.N. Development Program in Montenegro, shared with Devex.

In the last funding process, Montenegro received 6.4 million euros ($7 million) for HIV and AIDS and 1.3 million euros for tuberculosis.

A country’s income level and disease burden determine its eligibility to be a single applicant. HIV prevalence in Montenegro, an upper middle-income country, is low — as is the case in much of southeastern Europe. But Montenegro’s economy relies heavily on tourism, and there is a large seasonal influx of tourists from countries with high HIV prevalence, the UNDP program manager explained. Without NGOs working to keep prevalence rates low, Montenegro risks seeing a spike in HIV transmissions.

Unfortunately, given Montenegro’s other problems, including high unemployment rates and a stalled recovery from economic downturn, Labovic said that “HIV is really not important in the country.”

“We are certainly hoping that the criteria will change, because all of these countries in Eastern Europe have the same concerns and probably most of the NGO services will crash after the Global Fund leaves,” Labovic said. “It really would be important if at least the criteria for the services that are not covered by the state would be funded for some kind of transitional period.”

While Montenegro cannot apply again to the Global Fund as a single applicant, it could apply with other countries in the region.

Understanding the country context

For Save the Children in Nepal, meanwhile, the technical engagement has helped it understand where it is heading.

“We were so focused on attending to our own targets, the national targets, but there is lots more that needs to be done and to have a more strategic focus, so getting their involvement in this is definitely positive,” Chettry said.

But the Global Fund does not have an office in the country so its involvement up until now has been very remote, she explained. Understanding the country context becomes more and more important as things continue to change and so that the Global Fund can gauge where the country is right now. With the PPP’s more frequent and longer visits to Nepal, however, Chettry is hopeful Global Fund staff will be able to gain a better understanding of the country context.

“Close engagement is a positive move and this should go on. But there shouldn’t be too many changes,” Chettry said. “What I would like to see in the future is not the change of the country chief. If they have changes to the structure, they have different people on board and this means the people will have to learn and understand.”

What are your experiences of the Global Fund’s new funding model and what would you like to see in its 2017-2021 strategy? Let us know by leaving a comment below.

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About the author

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    Aliyah Esmail

    Aliyah Esmail is a freelance journalist and communications professional with a fascination for the economic and political realities facing nongovernmental organizations. She holds a bachelor’s degree from Carlton University in journalism and film studies and is now working on a postgraduate certificate from the Humanitarian and Conflict Response Institute in Global Health. She has worked for the government of Canada as well as a number of international organizations.