Global Fund country allocations: Who's in and out?

MANILA — The Global Fund to Fight AIDS, Tuberculosis and Malaria has yet to make final funding allocations to four countries. The multilateral donor, which was able to secure $14.02 billion in pledges at its replenishment conference in October 2019, announced funding allocations for over 100 countries in December 2019. The allocations show an increase of 23% compared to the previous funding cycle, 2017-2019, according to the fund. “Eligibility does not guarantee an allocation.” --— Global Fund Eligibility List 2020 The majority of countries received an increased allocation, with four of them receiving more than double the amount they got in the previous allocation period. According to the fund, countries with the highest disease burden and least economic capacity received more funding allocation overall, with 25% of the funding going to countries accounting for 80% of the burden of HIV, TB, and malaria. Meanwhile, countries affected by disasters, crises or those suffering from poor governance that are deemed challenging operating environments received 33% more funding in the current allocation period. The Democratic Republic of the Congo, which continues to battle out an Ebola outbreak, received one of the biggest allocations, at $644.9 million, 22.38% more than 2017-2019. But in terms of program allocations, Mozambique received the highest total allocation for HIV/AIDS, with a 71.2% increase, closely followed by South Africa, which received a 54.5% increase. Meanwhile, India received the highest allocation for TB at $280 million, which is almost the same as in the previous funding cycle. And Nigeria received the highest allocation for malaria at $417.89 million, 33.3% more than the last funding cycle. However, four countries — North Korea, Angola, Venezuela, and the Republic of Congo — have yet to receive a final allocation. A Global Fund spokesperson told Devex these countries will receive their final allocations after “further discussions” between the fund and partners in-country, adding that the main issues surrounding the discussions are specific to each country. The spokesperson didn’t expand on the issues involved in each country, except for North Korea, which received a proposed allocation of $41.7 million for TB and malaria back in September 2019. “The Global Fund is ready to launch a new grant for tuberculosis and malaria in DPRK and can proceed when the DPRK government agrees that UNICEF can sign the grant,” said the Global Fund spokesperson. The multilateral donor closed its grants in North Korea in 2018, arguing that the country’s unique operating environment had prevented it from “achieving the required level of assurance on the deployment of resources and the effectiveness of grants,” Seth Faison, the fund’s director of communications, told Devex in July. But advocates questioned the move and insisted the fund immediately resume its grants in the country, where thousands of TB patients rely on its financing for treatment. They have warned that remaining stocks of TB drugs are expected to run out by June 2020. In addition, several countries received a decreased allocation, with some reductions amounting to more than 20%. These countries include Sri Lanka, which received an allocation of $9.4 million compared with $12.5 million in 2017-2019; and the Dominican Republic, which received an allocation of almost $16 million versus $20.5 million in 2017-2019. Countries in transition Several countries didn’t receive an allocation for 2020-2022. These include Albania, Algeria, and Panama. Panama became a high-income country in 2018 and is therefore no longer eligible as per the Global Fund’s eligibility policy. Albania, an upper-middle-income country, also didn’t meet the fund’s eligibility criteria, which sets out that upper-middle-income countries should at least have a high disease burden. Algeria received its transitional funding for HIV in the previous cycle but remains eligible for a TB grant given its high disease burden. It didn’t receive an allocation however, along with Romania, which is also eligible for TB funding in 2020. Global Fund policy dictates that “eligibility does not guarantee an allocation.” The Global Fund spokesperson said Romania received its final allocation of funding for TB in 2017-2019. In addition, despite its high HIV burden, the fund has determined it does not meet the requirements of its eligibility policy, which states that upper-middle income countries with high disease burden may be eligible for an allocation for HIV and AIDS “if there are demonstrated barriers to providing funding for interventions for key populations, as supported by the country’s epidemiology.” However, the Global Fund has determined Russia, an upper-middle-income country, is eligible for an allocation of HIV in the current funding cycle. “Russia is eligible for an allocation for HIV, which goes to directly support nongovernmental and civil society organizations. Besides having a high HIV burden, Russia has notable barriers to provision of HIV services to key populations. Such barriers include laws and practices that impact provision of HIV services to men who have sex with men and people who use drugs,” the Global Fund spokesperson said. Meanwhile, six disease components in four countries are on transition funding — usually the last funding allocation that countries receive for a disease component that has become ineligible for Global Fund grant — in the current allocation period. These include malaria and TB in Guatemala, malaria in Guyana, HIV and TB in Kosovo, and HIV in Armenia. Three countries — Costa Rica, Malaysia, and Mauritius — are also expected to become high-income countries during 2020-2022, which the spokesperson said would make them ineligible for further Global Fund funding. But the spokesperson also cautioned that “these are projections, and not binding determinations.” “The Global Fund has the flexibility to provide exceptional additional allocations of transition funding, as per our eligibility policy. Also, while some countries are projected to move to high income (and therefore would be ineligible for future support) income classifications do not always change as projected,” the spokesperson said. The Global Fund encourages countries to plan ahead for future transitions from Global Fund financing to ensure continued coverage and minimal disruption in HIV, TB, and malaria programs.